Many services require a notification to or a review by Wellmark. If you do not follow notification requirements properly, you may have to pay for services yourself, so the information in this section is critical. For a complete list of services subject to notification or review, visit www.Wellmark.com or call the Precertification line at 800-558-4409.

Services for which you are required to notify your administrator in advance include:

hospitalization
home health care
skilled nursing facility confinement
hospice care
organ transplants

If you receive any of the above services from an in-network physician or at an in-network facility, you are encouraged, but not required, to notify administrators in advance.

If you are unsure whether advance notification is required for a particular service, call member services at 800-524-9242.

In an Emergency

In a true emergency situation, visit the nearest Emergency Room for care. Your services will be covered at the in-network rate, regardless of whether you use an in-network or out-of-network hospital. Emergency Room care for non-emergency situations is not a covered expense.

If you are admitted to the hospital from the Emergency Room, you or your doctor must call Wellmark’s Customer Service Department and notify them of your admission within 48 hours. If you are unable to call, someone else can call for you.