FAQ

 

 

 

 

 

Frequently asked questions

 

Your health plan

Wellpoint is a managed care organization (MCO) that provides HealthChoice benefits to eligible individuals. We’ve been helping Maryland citizens get low-or no-cost insurance since 1999. HealthChoice is the name of Maryland’s Medicaid plan.

Once you’re approved for Medicaid, there are several ways to choose Wellpoint as your MCO:

 

Your primary care provider

Yes, if your primary care provider (PCP) is part of the Wellpoint plan. If your PCP is not in our plan, we can help you select a new one. You can also choose or change your PCP online by logging in to your account.

 

 

You can change your PCP at any time. To find a provider in your area, use our Find Care search tool. Then, log in to your online account to change your PCP. You can also talk to a representative via Live Chat who can help.

 

If you change your PCP, we’ll send you an updated ID card. But the change will start right away.

In most cases, you will need a referral or OK from your PCP to see a specialist. To find out if you need a referral for a medical problem, please check your Member Handbook.

Your ID card

You’ll get your Wellpoint ID card in the mail within 30 days from the date we’re notified of your enrollment in Wellpoint. You can download a copy of your ID card using the Member ID Card tool on our website, or get a copy of your card on the Sydney Health mobile app.

If you go to the doctor’s office without your member ID card, you can tell them you’re with Wellpoint. The doctor’s office will call us to verify your information. You can also get a copy of your ID card on the Sydney Health mobile app. Do your best to bring your card with you to every appointment.

Talk to a representative via Live Chat who can help. You can also view and download these items on our website:

 

Your ID Card (log in to your account)
Member Handbook (English)

Member Handbook (Spanish)

Your benefits

Talk to a Member Services representative via Live Chat who can help or view your Member Handbook. You can also call Maryland Health Connection at 855-642-8572 (TTY 855-642-8573) or visit MarylandHealthConnection.gov.

 

 

 

Notify Maryland Health Connection in one of these ways:

Your prescription drug coverage

You can get prescriptions filled at any Wellpoint plan pharmacy. It includes most major chains and many independent community pharmacies. You can search our list of pharmacies. You can also call Pharmacy Member Services at 833-205-6003 (TTY 711) or ask your local pharmacy for help.

 

Find a pharmacy 

Many OTC products are covered by Wellpoint, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any network pharmacy.

Your doctor can request preapproval on medicines by calling the Wellpoint Pharmacy department at 800-454-3730.

We work with pharmacies in all 50 states. Most chain pharmacies as well as many independent and grocery store pharmacies participate. If you need a refill while on vacation, contact your doctor for a new prescription to take with you. To view a list of network pharmacies, you can search our online provider directory.

If your medicines are lost or stolen, you should contact your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact us for prior approval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.

If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail a completed reimbursement request form along with any receipts to:

 

Commercial/Medicaid Claims Department

P.O. Box 52065

Phoenix, AZ 85072-2065