Well Sense Health Plan uses criteria for reimbursing and covering specific services or medications. The following policies are used as a guide by the plan to make determinations regarding health care reimbursement and healthcare coverage. Our policies undergo regular updates; check back often for the most up-to-date information.
- Medical Policies
- Reimbursement Policies
- Pharmacy Policies
- Durable Medical Equipment Policies
- Radiology Policies
Providers are reminded that member eligibility is determined before medical coverage policies and reimbursement guidelines are applied to any claim. As a result, the Plan can not guarantee payment when a member is ineligible or a non-covered benefit is rendered.