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State of Emergency: Significant Storm-Related Impacts Affecting Four More Counties

Support for impacted Wellcare members

On April 20, 2023, Governor Gavin Newsom declared a state of emergency for an additional four counties as a result of heavy rainfall, high winds, flooding, downed trees, and damage to roads and critical infrastructure, which began in February: Contra Costa, Riverside, San Diego and Yolo counties.

At Gov. Newsom’s request, President Biden has issued a Presidential Emergency Declaration and a Presidential Major Disaster Declaration, which have since been expanded to include additional counties, to bolster state and local storm response efforts.

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 significant 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.

Filing claims

The deadline to file claims for providers affected by the significant storm-related impacts will be extended. Providers may contact the Provider Services Center using the contact information in the right-hand column of page 1 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 four impacted counties whose medication was lost in a flood 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 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 significant 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 storm impacts.

Additional information

Depending on how the significant storm-related impacts 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.

This update applies to: Physicians, Hospitals, Ancillary Providers, Independent Practice Associations