June 20, 2023
Support for Wellcare members impacted by this state of emergency
On June 16, 2023, Governor Gavin Newsom declared a state of emergency in Ventura County due to the ongoing impacts of winter storms – including the collapse of a local sewer line – that began in February of this year. Wellcare is providing assistance to members in Ventura County affected by the ongoing impacts of the winter storm.
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 collapsed sewer line and other storm-related impacts are able to continue providing care for members’ medical needs.
Participating providers may call the Provider Services Center using the contact information in the right-hand column of this page 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.
The deadline to file claims for providers impacted by the state of emergency will be extended. Providers may contact the Provider Services Center using the contact information in the right-hand column of this page for additional guidance on claims extension time frames.
Wellcare will approve any essential prescription medications (with current copayments and deductibles) for any member in Ventura County whose medication remained behind during an evacuation. 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.
Due to the collapsed sewer line and other storm-related impacts 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 state of emergency.
Depending on how this state of emergency progresses, 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 or through the provider website as listed in the right-hand column on page 1.
This information applies to Physicians, Hospitals, Ancillary Providers, and Independent Practice Associations (IPAs)