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.
To find out how your medical information may be used and disclosed, review Wellmark's Privacy Practice Notice PDF File.
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.
The right to appeal and the external review information is also available when reviewing a claim in myWellmark®.
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.
To ensure that our members have access to the best possible care, we regularly review the latest procedures, drugs, devices and methods.
After enrolling in a Wellmark health plan, you'll receive your coverage manual, which outlines your plan benefits, and provides information on:
To view your coverage manual, log in to log in to myWellmark. If you have questions, please contact Customer Service.
Quality at Wellmark is part of everything we do. 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. Wellmark is also Accredited by National Committee for Quality Assurance (NCQA), a non-profit organization dedicated to improving health care quality.
You can rest assured knowing coverage decisions are based on the medical appropriateness of care, services, and your benefit plan. To make sure you receive the highest quality and safest care:
Case 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.
When faced with a serious diagnosis, multiple conditions or complex conditions, you and your family have many tough choices to make. Wellmark's Case Management Program can help you navigate the health care system and provide support during your time of need. Case management services are available to you by calling 800-552-3993.
To learn more about Wellmark's Case Management Program, log in to myWellmark® or call BeWell 24/7 at Eight, Four, Four, Eight, Four, Be Well.