Frequently Asked Questions

You will be receiving your ID card and Welcome Kit in the mail. Remember to bring your ID card to all of your doctors' appointments and whenever you pick up prescriptions.

In an emergency (inside or outside the Service Area), you should call 911 or seek care at the nearest Emergency facility. If 911 services are not available in your area, call the local number for Emergency medical services.

Not sure if you need to go to the emergency room? Call our free Nurse Advice Line (1-866-763-4829) for guidance. Registered nurses are available around the clock to answer your health questions and possibly save you a trip to the hospital or emergency room.

If you are not feeling well and your Primary Care Physician (PCP) is unable to see you, or if it is after business hours, you can ask if another doctor in the practice is able to see you. This can be helpful in situations that do not require an emergency room visit, but may not be able to wait until your PCP is next available.

You need to choose a doctor for all your routine care. Your doctor, also called a Primary Care Physician or PCP, should be the first person you call when you have medical issues (unless it's an emergency). Your doctor will help you manage your health and send you to specialty doctors or hospitals when needed.

If you don't choose a doctor, one will be assigned to you—but you can change at any time.

Generally, any doctor or hospital that you visit must be chosen from a list of providers who work with WellSense. They are also called “in-network” providers. Your doctor will refer to you other doctors or hospitals on our approved list to make sure that your medical visit is covered by insurance (there are some exceptions). See a list of doctors and hospitals you can use.

For a complete list of the services covered by WellSense, read the Covered Services List that came in the mail or find it here. This is the most important document you have, since it tells you what WellSense will/will not cover.

There may be times when you may need to see a specialist. A specialist is a healthcare provider who is trained to offer specific, often more detailed, treatments than your PCP. If you think you need to see a specialist, you should first call your PCP. Your PCP can help you identify your specialty care needs.

Some services and medications need prior approval or prior authorization, from WellSense before they will be covered. Your PCP will get this approval for you, which is why it is important that you choose a doctor that you are comfortable with who can get to know your health care needs.

If you or your PCP did not receive prior approval, WellSense will not pay your doctor for your care or services. Your doctor may hold you responsible for the costs of your treatment.

In general, you must get all your healthcare services from WellSense network doctors and providers. The only exceptions are:

  • If you need emergency care (or treatment at the closest emergency room for serious illness or injury in a life-threatening situation)
  • If you need urgent care when you are traveling outside our service area
  • If you need family planning services
  • If WellSense (or Beacon Health Strategies for behavioral health services) gives prior approval, also called prior authorization, for you to get care from an out-of-network provider

If you did not receive prior approval, you will be responsible for the costs of your visit, except for the situations listed above.

We partner with Carelon Behavioral Health to manage Behavioral Health services. Call Carelon for help finding a provider for Behavioral Health services. 

  • 1-855-834-5655: Toll-free, 24-hour Behavioral Health telephone line.
  • 1-866-727-9441: TTY/TDD for hearing impaired.
  • MDLive Speak with board-certified therapists or psychiatrists from your computer or phone.

Yes. Call the Nurse Advice Line at 1-866-763-4829 (TTY/TDD) and speak to a registered nurse when your doctor's office is closed or if you have a question about your health. All calls are confidential and you can call anytime, seven days a week.

Our Care Management Program can make living with conditions like asthma, diabetes, cancer, or other special health needs easier. Pregnant members can get help through this program too. Call 1-855-833-8119 to see if you or your family members qualify.

Yes, we provide our members with rides to covered medical services. If you need transportation, you must call the WellSense Transportation line at 1-844-909-7443, toll-free, available 24-hours, seven days a week.

We are committed to improving your health and health care. Well Sense Health Plan has made it easier for you to access your personal health information which can help you make more informed decisions about your health care. Click here for more information on how to access your health information online.

Remember, you can call Member Services at 1-877-957-1300 (TTY/TDD: 711) for help with any of the items above and much more.