Support for Wellcare Members Impacted by Winter Storms
On March 22, 2024, Governor Gavin Newsom expanded his state of emergency, based on impacts from the winter storms causing high winds, heavy rain, mudslides and power outages.
The impacted counties from that declaration include: Alameda, Butte, Glenn, Lake, Mendocino, Monterey, Sacramento, San Francisco, Santa Cruz, Sonoma and Sutter counties.
Additionally, Governor Newsom requested a Presidential Major Disaster Declaration for several communities impacted by widespread flooding, mudslides and debris flows during the storms.
The Presidential Major Disaster Declaration request includes the counties of Butte, Glenn, Los Angeles, Monterey, San Luis Obispo, Santa Barbara, Santa Cruz, Sutter and Ventura counties. If approved, the declaration would make available federal public assistance funding to help state, tribal and local governments cover emergency response and recovery costs. The request also includes funding for hazard mitigation efforts statewide.
We want to help ensure that members who have been impacted, because they or their usual health care providers have been temporarily displaced, have continued access to health care services and prescriptions during the state of emergency.
Here is what you need to know.
Prior authorization, precertification and referrals
Wellcare is taking steps to ensure that participating providers in areas affected by the winter storms are able to continue providing care for members’ medical needs.
Participating providers may call the Provider Services Center at 1-866-999-3945 for guidance on:
- Shortening time limits for health care service plans to approve prior authorization, precertification, or referrals, and extending the time that prior authorizations, precertification, and referrals for treatment remain valid.
- Approving out-of-network services in the event a contracting provider or facility becomes unavailable.
- Authorization for the replacement of medical equipment or supplies.
Filing claims
The deadline to file claims for providers impacted by the winter storms will be extended. Providers may contact the Provider Services Center at 1-866-999-3945 for additional guidance on claims extension time frames.
Prescription information
Wellcare will approve any essential prescription medications (with current copayments and deductibles) for any member in the 13 impacted counties whose medication treatment was interrupted by the storms. Wellcare will also suspend prescription refill limitations and allow an impacted enrollee to refill their prescriptions at an out-of-network pharmacy. Providers should inform their patients that to obtain an emergency supply, affected members can return to the pharmacy where the original prescription was filled. If the pharmacy is not open due to the state of emergency, affected members can contact Wellcare at 1-866-999-3945 for questions or assistance.
Member insurance cards and health care information
Members whose insurance cards have been lost or left behind due to the state of emergency and members who have health care questions during the state of emergency can contact Wellcare at 1-866-999-3945 for questions or assistance.
Coping assistance
Wellcare members who lost their homes or have been evacuated due to the storm may contact 1-866-999-3945 for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss or other trauma resulting from the storms
Additional information
Depending on how the storms progress, Wellcare may make additional changes to its policies as needed to ensure members have access to necessary health care services.
If you have questions regarding the information contained in this update, contact the Provider Services Center by phone at 1-866-999-3945 or through the provider portal at provider.wellcare.com/california.
