A step-by-step guide on how to use your WellSense plan, including a chart describing who to contact based on common symptoms.
1. Pick a doctor.
Choose a doctor, nurse practitioner or physician assistant to be your primary care provider (PCP) for all your routine care. They will make sure you are up to date on vaccines and screenings and will send you to specialists when needed. Once you choose a PCP, log in to your account or call us to let us know who you picked. Put your PCP phone number in your phone for easy access in the future.
2. See what medications are available and what they cost.
We cover thousands of medications. See if your medications are on the list.
3. See what services are covered.
Learn how to take full advantage of your plan benefits — including your FREE extras. Get to know your benefits documents and refer back to it when you need to find out if a service is covered. When in doubt, please call and ask us before you get the service. We don't want you to receive a surprise bill.
In some cases you will need prior approval before a service will be covered. You or your doctor can confirm if the service requires a prior authorization by checking our Medical Procedure Code Lookup Tool or our Supplies and Services Code Lookup Tool.
4. Know who to call.
Sometimes you may feel sick when your PCP isn’t available. Your PCP’s office may have doctors or nurses available for these situations.
- For routine care, call your PCP during business hours.
- For urgent care needs that happen after hours, please call your PCP first. If your PCP office is not available, try our 24/7 Nurse Advice Line.
- If you are having a true emergency, please call 911.
|Well visits and checkups||x|
|To renew a prescription||x|
|Sore throat, runny nose, slight fever or cold symptoms||x||x|
|Severe stomach pain with vomiting||x||x||x|
|Earache, eye soreness or pink eye||x||x|
|Allergies and rashes||x||x|
|Flu shot or other vaccine||x||x|
|Sprains or twists||x||x|
If in doubt about who to contact for care, call our free Nurse Advice Line 1-800-973-6273. Nurses are available around the clock to answer your health questions and possibly save you a trip to the hospital or emergency room.
WellSense is committed to ensuring that the healthcare services provided to eligible members are done so by providers entitled to participate in federal programs, are medically necessary, meet certain quality requirements, are provided in a cost-effective manner, are billed appropriately and paid according to contract terms and our policies. To learn more about fraud, waste, and abuse, as well as how you can report it, click here.