Continuity of Care
You may be eligible for Continuity of Care
If you’re currently receiving treatment for one of the following conditions AND the provider(s) who has been administering that treatment was in-network with your employer’s previous insurer, but is not in Wellmark’s provider network, you may be able to continue receiving care from the provider or facility for the condition at your in-network level of benefits until the treatment is complete or for the first 90 days of your coverage with Wellmark (whichever is shorter). You may qualify if you are:
Undergoing a course of treatment for a serious and complex condition from the provider or facility
Undergoing a course of institutional inpatient care from the provider or facility
Scheduled to undergo nonelective surgery from the provider, including receipt of postoperative care from such provider or facility with respect to such a surgery
Pregnant and undergoing a course of treatment for the pregnancy from the provider or facility
Determined to be terminally ill (as determined under section 1861(dd)(3)(A) of the Social Security Act and are receiving treatment for such illness from such provider or facility.
If you qualify, please see HR for necessary paperwork.
Determine your provider’s network status
If you are currently undergoing treatment for a qualifying condition listed above, you’ll need to determine if the provider(s) and/or facility you are receiving treatment from are in your new Wellmark plan network. If your provider is in the Wellmark network, you are not eligible for Continuity of Care. If your provider or facility is not in the network, you may apply for Continuity of Care, or choose an in-network Wellmark provider.
Applying for Continuity of Care
To apply to receive in-network benefits for up to 90 days for your care from the provider or facility, you will need to notify Wellmark by doing the following:
Review and complete the information requested on the enclosed Application for Continuity of Care
Sign and return the application to Wellmark Blue Cross and Blue Shield by following the instructions listed on the application form linked here.
Once your information is received, Wellmark will review it and notify you and your provider if the application is approved. If it is approved, you will receive benefits for treatment from this provider or facility at an in-network level and your claims will process normally for up to 90 days, as long as you are still enrolled in your new health plan. You will still be responsible for any deductibles, coinsurance or copayments that may apply.
You have 30 days following the effective date of your new health insurance coverage with Wellmark to elect Continuity of Care by submitting your information. If you do not apply for Continuity of Care during this period, any claims submitted by this provider or facility will be treated as out-of-network claims in accordance with the terms of your health plan.
Using in-network providers helps you save money
Choosing an in-network doctor is the simplest way to save on your health care costs. Simply use the Find a Provider or Hospital tool on Wellmark.com to find an in-network provider in your area.
If you continue to receive services from a provider who is out-of-network, and you are not eligible for Continuity of Care, you may be responsible for paying the full amount charged and filing your own claims. Generally, you will pay a higher amount when you receive services from an out-of-network provider, and in some cases, you may only be covered for services received by out-of-network providers in the case of an emergency or if you have an approved out-of-network referral.
Call with questions
If you have any questions about your health plan benefits or how to find an in-network provider, please call Wellmark Customer Service at the phone number on your ID card.