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24-126: State of Emergency Due to Intense Rainfall in San Diego and Ventura Counties

January 26, 2024

Support for Wellcare members impacted by the significant rainfall in late December and January

On January 23, 2024, California Governor Gavin Newsom declared a state of emergency in San Diego and Ventura counties due to the significant rain which has caused flooding, mudslides, debris flows and other hazardous conditions. Wellcare is providing assistance to members in San Diego and Ventura counties affected by the significant rainfall.

We want to help ensure that members who have been impacted, because they or their usual health care providers have been temporarily displaced, have continued access to health care services and prescriptions during the state of emergency.

Here is what you need to know.

Prior authorization, precertification and referrals

Wellcare is taking steps to ensure that participating providers in areas affected by the significant rainfall are able to continue providing care for members’ medical needs.
Participating providers may call the Provider Services Center using the contact information in the right-hand column of this page for guidance on:

  • Shortening time limits for health care service plans to approve prior authorization, precertification, or referrals, and extending the time that prior authorizations, precertification, and referrals for treatment remain valid.
  • Approving out-of-network services in the event a contracting provider or facility becomes unavailable.
  • Authorization for the replacement of medical equipment or supplies.

Filing claims

The deadline to file claims for providers impacted by the significant rainfall will be extended. Providers may contact the Provider Services Center using the contact information in the right-hand column of page 1 for additional guidance on claims extension time frames.

Prescription information

Wellcare will approve any essential prescription medications (with current copayments and deductibles) for any member in San Diego or Ventura counties whose medication was lost in a flood or mudslide or remained behind during an evacuation. Wellcare will also suspend prescription refill limitations and allow an impacted enrollee to refill their prescriptions at an out-of-network pharmacy. Providers should inform their patients that to obtain an emergency supply, affected members can return to the pharmacy where the original prescription was filled. If the pharmacy is not open due to the state of emergency, affected members can contact Wellcare at1-866-999-3945 for questions or assistance.

Member insurance cards and health care information

Members whose insurance cards have been lost or left behind due to the state of emergency and members who have health care questions during the state of emergency can contact Wellcare at 1-866-999-3945 for questions or assistance.

Coping assistance

Wellcare members who lost their homes or have been evacuated due to the storm may contact 1-866-999-3945 for referrals to mental health counselors, local resources or telephonic consultations to help them cope with stress, grief, loss or other trauma resulting from the state of emergency

Additional information

Depending on how the effects of the rainfall progress, Wellcare may make additional changes to its policies as needed to ensure members have access to necessary health care services.

If you have questions regarding the information contained in this update, contact the Provider Services Center by phone or through the provider website as listed in the right-hand column on page 1.

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Y0020_WCM_100876E Last Updated On: 2/9/2024