Important things to know | Wellmark
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Be an Informed Member

A few things to know

To help you make the best decision for you and your family, this information explains your rights as a member, and the protection you expect from Wellmark.

As a member, it’s important that you know your rights and responsibilities. This can help you make informed health care decisions and have more control over your well-being. 

Your information is secure

At Wellmark, we have strong policies and systems regarding the use and disclosure of your personal and medical information. And they’re all designed to protect you. Learn how Wellmark is protecting your personal health information.

To find out how your medical information may be used and disclosed, review Wellmark's Privacy Practice Notice PDF File.

View transparency in coverage information.
Know the differences between health care plans, and you'll feel good about the choices you're making for you and your family. Get the facts (available in more than 20 languages).

Some services and procedures may need authorization before you receive them. To avoid out-of-pocket expenses, learn which ones require authorization and why.

Paying your claims

After receiving your claim, Wellmark has a proven and secure process for paying providers.

If for some reason, a claim is denied, partially-denied or covered by a reduced payment, you can request a review through our Claims Appeal and External Review Process.

Our prescription drug coverage can help you reduce out-of-pocket drug costs. For details about your benefits, including which drugs may require authorization, review the Wellmark Drug Information page

No one plans to get injured or become sick. But if you or a family member has a medical issue serious enough to need quick attention, urgent care may be the answer.

In a medical emergency, get qualified help immediately.
With your Wellmark health plan, you’re covered 24 hours a day, anywhere you go for emergency medical services.

As a member, you also have coverage wherever you travel through the BlueCard® program

One of the best ways to manage health care costs is to choose an in-network provider. They’ve agreed to provide services at the prices allowed by Wellmark, so you won’t be surprised by extra costs or charges. However, if you see an out-of-network provider, your benefits may not apply at all. 

Also before receiving a service, be sure to check that it’s covered by your plan.

A list of Wellmark’s network health care providers and participating facilities is available on the Find a Provider or Facility tool External Site, or by contacting Customer Service at the phone number on your ID card.

If you have questions about providers’ qualifications such as board certification status, medical school attended, and completion of residency, contact them directly.

To ensure that our members have access to the best possible care, we regularly review the latest procedures, drugs, devices and methods

If standard treatments isn't helping your medical condition, and you're considering alternative therapies, we encourage you to review our policy on investigational and experimental treatments.

After enrolling in a Wellmark health plan, you'll receive your coverage manual, which outlines your plan benefits, and provides information on: 

  • Covered and non-covered benefits, which are located in the "Details - covered and not covered" section of the manual.
  • Copayments and other charges you're responsible for paying, which are located in the "Factors affecting what you pay" section of the manual.
  • How to file a claim, which is located in the "Claims" section of the manual.
  • How to submit a complaint, which is located in the "General provisions" section of the manual.

Take the time to review your manual. If you have questions, please contact Customer Service

Quality at Wellmark is part of everything we do. You can rest assured knowing coverage decisions are based on the medical appropriateness of care, services, and your benefit plan. We are committed to quality by working with providers to keep you healthy, creating healthy communities and providing tools, resources and programs to help you manage your health and spending.

To make sure you receive the highest quality and safest care:

  • Wellmark does not reward providers for denying services
  • Wellmark does not reward coverage decisionmakers for decisions that result in a denial of coverage or service

Care Management programs help support members by managing chronic medical conditions and diseases, ongoing health maintenance and preventive services. These programs also provide care coordination, which includes the use of health care services, continuity of care and care coordination across health settings.

Advanced Care Program

When faced with a serious diagnosis, multiple conditions or complex conditions, you and your family have many tough choices to make. The Advanced Care Program can help you navigate the health care system and provide support during your time of need. Advanced care services are available to you by calling 800-552-3993.

To learn more about Wellmark's Care Management Programs, log in to myWellmark® or call BeWell 24/7 at 844-842-BeWell (239355).