January 10, 2025
Support for Wellcare members who are impacted
On January 7, 2025, Governor Gavin Newsom declared a state of emergency in Los Angeles and Ventura counties due to the high winds, low humidity and extreme fire weather. Wellcare is providing assistance to members affected by the fires.
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 fires are able to continue providing care for members’ medical needs. This includes extending grace periods for notifications, starting from the admission date, for acute, post-acute, durable medical equipment (DME), medical supplies, and home health care services. You do not need to receive prior authorization. Please note that while the notification deadlines are relaxed, the requirement to notify us remains in place. Additional steps we are taking include:
- Flexibility for submitting updated clinical documentation for continued stay reviews.
- Post-admission notification approvals for impacted facilities.
- Approval of out-of-network services in the event a contracting provider or facility becomes unavailable.
- Granting authorization for the replacement of medical equipment or supplies.
For additional guidance and questions regarding above, contact the Provider Services Center using the contact information below.
Filing claims
The deadline to file claims for providers impacted by the fires will be extended. Providers may contact the Provider Services Center using the contact information below 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 whose medication was lost in a fire or 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 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 fires and members who have health care questions during the state of emergency can contact Wellcare at 866-999-3945 for questions or assistance.
Coping assistance
Wellcare members who lost their homes or have been evacuated due to fires may contact 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 fires.
Additional information
Depending on how the fires 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 866-999-3945 or through the provider website at provider.wellcare.com/california.
