What People on Medicare
Need to Know About
Private Fee-for-Service Plans
WellCare is a Medicare Advantage Private Fee-for-Service (PFFS) plan authorized by the Centers for Medicare & Medicaid Services (CMS). A PFFS plan is different than Original Medicare or an HMO, PPO, or Medicare supplement plan.
WellCare gives you the ability to choose your health care provider. However not all providers may accept this plan; even Medicare providers may not accept this plan. If you choose this plan, it is very important that all the providers you choose know, before providing services to you, that you have WellCare coverage in place of Medicare. This gives your provider the right to choose whether or not to accept WellCare’s terms and conditions of payment for treating you. Providers have the right to decide if they will accept WellCare each time they see you. This is why you must show your WellCare ID card every time you visit a health care provider.
If your provider agrees to WellCare terms and conditions of payment
If your provider decides to accept the WellCare plan, they must follow our plan’s terms and conditions for payment. They must thereafter bill WellCare for those services. However, providers have the right to decide if they will accept WellCare each time they see you.
If your provider does not agree to WellCare’s terms and conditions of payment
A provider may decide not to accept WellCare’s terms and conditions of payment. If this happens, you will need to find another provider that will.
You may contact us at 1-866-207-6301 (TTY/TDD users 1-866-239-6265),
Monday – Sunday, 8am to 2am Eastern, for assistance locating another provider in your area willing to accept our plan’s terms and conditions of payment.
What happens if a provider declines to accept WellCare’s terms and conditions of payment?
1. They should not provide services to you except for emergencies.
2. If they choose to provide services, they may not bill you. They must bill WellCare for your covered health care services. You must pay the appropriate co-pays or coinsurance at the time of service.
For more information about PFFS plans, see “Beneficiary Qs & As” at CMS’s Web site: http://www.cms.hhs.gov/PrivateFeeforServicePlans/. If you have questions about WellCare, please call our Customer Service Department at 1-866-238-9898 (TTY/TDD users 1-866-239-6265), Monday – Sunday, 8am to 2am Eastern.
What Health CareProviders
Need to Know About
Private Fee-for-Service plans
WellCare is a Medicare Advantage Private Fee-for-Service (PFFS) plan authorized by the Centers for Medicare & Medicaid Services (CMS). A PFFS plan is different than an HMO, PPO, or Medicare supplement plan.
A beneficiary who enrolls in a Medicare Advantage PFFS plan is free to use any provider willing to treat the enrollee and accept our plan’s terms and conditions of payment. You can view our terms and conditions of payment by visiting our Web site at www.wellcarepffs.com, and if you have questions, then you can call us at 1-866-235-2770. Enrollees must inform you, before obtaining services from you, that they have purchased WellCare for their Medicare coverage. This gives you the right to choose to accept WellCare enrollees. You have a right to make that choice each time service is needed by a WellCare enrollee. You do not have to sign a contract to see WellCare enrollees.
If you decide to accept WellCare’s terms and conditions of payment
Your agreement to our plan’s terms and conditions of payment is inherent in your decision to treat a WellCare enrollee. If you decide to treat a WellCare enrollee, you will be subject to our plan’s terms and conditions of payment and must bill WellCare for covered services. However, you have the right to decide, on a patient-by-patient and visit-by-visit basis, whether to treat WellCare enrollees. You may learn our terms and conditions of payment and other information about our plan on our Web site at www.wellcarepffs.com.
If you decide not to accept WellCare’s terms and conditions of payment
If you decide not to treat a WellCare enrollee, you should not provide services to the enrollee, except for emergencies.
If you choose to provide services, then you have by default agreed to our terms and conditions of payment, and you must bill WellCare for covered health care services. You must collect from the enrollee only the appropriate WellCare co-pays or coinsurance at the time of service. You may at any time, on a patient-by-patient and visit-by-visit basis, decide that you do not want to treat a WellCare enrollee.
We will follow CMS requirements for timely payment of claims. You may learn our billing requirements on our Web site at www.wellcarepffs.com or by calling us at 1-866-235-2770.
For more information about PFFS plans, see “Provider Qs & As” at CMS’s Web site http://www.cms.hhs.gov/PrivateFeeforServicePlans/. If you have questions about WellCare, please call our Provider Relations Department at 1-866-235-2770.