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Out of Network Coverage (Part C)

In most cases, you must receive your care from a Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) doctor. There are some times when network providers may not be offered or nearby. Those times are:

  • In an emergency.
  • When urgent care is needed that you cannot get from a network provider.
  • When care is needed that cannot be offered by a network provider.
  • For continuity of care.
  • When kidney dialysis services are needed when you are outside the plan’s service area for a short time. Please call Member Services before you leave the service area. We can help you get dialysis while you are away.

In some cases your doctor may send you to an out-of-network doctor. Your doctor will need to get prior authorization from the health plan. Some of those times may be because:

  • You have a rare medical condition and you can’t get care from a network doctor.
  • Services are available in-network but are not available as soon as you need them.
  • Your doctor decides that a non-network provider would be better for you.

See the Benefits Chart in your Member Handbook for more information.

If you have any questions, call Member Services at 1-855-735-4398 (TTY:711). Hours are from 8 a.m. to 8 p.m., Monday through Friday.  After hours, on weekends and on federal holidays, you may be asked to leave a message.

A representative checks messages daily for fast appeals. Your call will be returned within the next business day or sooner if required for a fast appeal.

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Last updated:  10/01/2024
Material ID:  H1723_WEBSITE_2025_PENDING

Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Wellcare Prime Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Wellcare Prime members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-855-735-4398 (TTY: 711) or visit mmp.absolutetotalcare.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email ATC_SC_MMP@centene.com.


Last updated:  10/01/2024
Material ID:  H1723_WEBSITE_2025_PENDING

Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Wellcare Prime Member Handbook.

Out-of-network/non-contracted providers are under no obligation to treat Wellcare Prime members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network.

If you need help finding a network provider and/or pharmacy, please call 1-855-735-4398 (TTY: 711) or visit mmp.absolutetotalcare.com to access our online searchable directory. If you would like a Provider/Pharmacy Directory mailed to you, you may call the number above, request one at the website link provided above, or email ATC_SC_MMP@centene.com.