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.