Welcome. We're glad you're with us.
Select your plan type from the list below and you'll find helpful information to help you get started with your plan, save money when you obtain healthcare, and get the most out of your coverage.
LifeWise's medical plans do not cover all health care expenses and include limitations and exclusions. Please refer to your benefit booklet to determine which services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan may contain exceptions to this list based on state mandates, essential health benefits, or the plan design purchased.
A primary care provider (PCP) is a health care practitioner who sees people that have common medical problems. This person may be a family doctor, internal medicine doctor, pediatric doctor, physician assistant, or a nurse practitioner.
Having a primary care provider can give you a trusting, ongoing relationship with one medical professional over time. Your PCP's role is to:
While having a primary care provider is not required, you are encouraged to select a doctor to provide primary care services. You can select an in-network PCP by looking in our online “Find a Doctor” directory where you will find a list of in-network primary care providers. Customer Service can also help you find doctors, dentists and hospitals in your area and provide details about their services and professional qualifications.
While you are not required to select a primary care physician, these practitioners can assist you to maintain and monitor your health and access the services of specialty care doctors.
Have you changed plans? Is your healthcare provider no longer in-network?
Use the Transition of Care Worksheet to see if you can continue your care with your present healthcare provider at the in-network level.
Did you know that the following tests and treatments are often not needed and may be harmful to your health?
You have options if you need after office hours or emergency care. Sometimes it's hard to know what to choose, but there's a big difference in time and money.
24-Hour NurseLineCall our FREE and CONFIDENTIAL 24-Hour NurseLine to speak with a registered nurse who will ask the right questions, listen to your concerns, and help you determine where and when to seek treatment. The NurseLine number is listed on the back of your ID card. Note: if there isn't a NurseLine number on your card your plan may not participate with the NurseLine service.
Non-Life Threatening Urgent care facilities provide quick, convenient care for health needs that aren't life threatening but can't wait until the next day or longer. They are open outside of regular business hours and are less expensive than emergency room care. To locate the nearest urgent care facility, search our find a doctor directory (choose “Facilities by Specialty” then select “Urgent Care” specialty).
Conditions that can be dealt with in an urgent care facility:
Life ThreateningCall 911 or go to the emergency room if you are in severe pain or your condition is endangering your life.
To locate the nearest ER, search our find a doctor directory.
Examples of medical emergencies:
LifeWise members have access to a comprehensive, nationwide network of retail pharmacies and access to a convenient mail order pharmacy, Express Scripts Home delivery. To find information about your drug benefits use the following links.
Find a network pharmacy near you:Find an in-network pharmacy
View pharmaceutical management procedures (procedures that affect your drug coverage):View drugs that require Prior Authorization (exception requests)Learn how to obtain coverage for non-formulary drugs if you have a closed formulary planView drugs subject to Pre service reviewLearn what LifeWise does to keep costs down
View your drug list and see which drugs have limitations to prescribing or access:Search drug lists with Rx SearchVisit Express Scripts to view your personalized pharmacy benefits
Learn how to obtain restricted pharmaceuticals:Use Rx Search to learn which drugs have restrictions, quantity limits and step therapyVisit Express Scripts to find your copay for a restricted prescriptionLearn about prescription mail-order
The goal of the Utilization Management program is to promote the delivery of appropriate, effective and efficient medical care to our members. This includes medical services, medical equipment and pharmacy. If you have questions about the Utilization Management Program, please contact Customer Service.
Collect calls are also accepted by calling 800-596-3440 TTY and language assistance is available for callers with questions about Utilization Management. Our TTY number for deaf or hard of hearing members is 800-842-5357.
LifeWise and its delegates do not reward or pay our staff based on how members use healthcare services. We do not base their pay in any way on how or if they decide to approve or deny coverage. We do not reward or pay our staff to make decisions that cause members to use fewer healthcare services.
We do review some healthcare services before members get them. These reviews help us decide if and how to cover those services. When we do a review, we look only at whether services meet medical criteria for your condition and whether your plan covers them.
“We” includes LifeWise and any of its delegates, any people or organizations we hire to review requests.
LifeWise is committed to assuring quality care for its members. Our Quality Program makes sure that the healthcare our members receive is evaluated, measured, improved, and communicated about. LifeWise’s Quality program is designed to improve members’ health and the quality and safety of care and service. The Quality Improvement Committee conducts a formal, system wide quality assessment annually which includes an annual program evaluation of the quality of its health services.
• Safety information
It's important to think about safety when you need healthcare. Talking with your doctor is perhaps the most important link to better care and health results. The links below provide useful tools to help you talk with your doctor about care and medications.
• Choosing the right tests and treatments
Did you know that the following tests and treatments are often not needed and may be harmful to your health?
Check out Choosing Wisely: 5 Questions to Ask Your Doctor Before You Get Any Test, Treatment, or Procedure to learn more.
• Medication list
For a Medication List in English and Spanish and a variety of Tips and Tools related to medications, go to: http://www.safemedication.com
• 10 questions to ask
Asking questions is important to safe care! The Agency for Healthcare Research and Quality provides useful resources including The 10 Questions You Should Know
• Ask Me 3™
The Ask Me 3™ is a program designed to promote communication between health care providers and patients in order to improve health outcomes. The program encourages patients to ask and understand the answers to three questions:
• 5 Steps to safer care
A patient safety fact sheet tells what you can do to ensure safer health care, “Five Steps to Safer Health Care” is available from the Agency for Healthcare Research and Quality.
LifeWise offers personal health support to you or your family members who have the following chronic health conditions:
This service is voluntary and is offered at no extra cost to you as part of your health plan. We identify members who may be eligible for this program through review of claims and by referrals from doctors and healthcare providers. If you have one of the above conditions, you may be automatically enrolled in this service.
Once enrolled, you'll receive quarterly newsletters with information on how to improve your health. You may also be eligible for a dedicated Personal Health Support Coach. Our health coaches are nurses, dieticians and counselors who can help you identify the barriers to good health and help you better understand your condition.
If you wish to discontinue this service, or you would like more information about it, you can call one of the numbers below.
How to Ask for HelpYou may refer yourself or a family member by calling:
Or email us at firstname.lastname@example.org.
More information on Diabetes
More information on Asthma
More information on COPD
More information on Coronary Artery Disease (CAD) and Heart Failure
Personal Health Support offers support to help you or a family member with serious health problems. With this service, a nurse or clinician case manager will help you with any concerns you have with your health or healthcare. This service is voluntary and free as part of your health plan.
How to Make a Referral
You may refer yourself or an eligible family member for case management services. Call 800-596-3440 or email us at email@example.com
Make sure you're covered
Don't be surprised by a bill you weren't expecting
Did you know that you may be required to get an approval for coverage from your health plan before you have a planned medical service or procedure? This is called a preapproval, and it helps you:
Learn more about preapprovals
These are your rights as a health plan member.
These are your responsibilities as a health plan member.
When you receive care from providers in the network, they will process your claims directly with us, so you don't need to handle any paperwork. However, if you receive care from a non-network provider, you may have to pay the provider for the service and then file a claim with us for reimbursement.
To file a claim for reimbursement, simply follow these steps:
Please see your Benefit Booklet for more details on filing claims.
If you disagree with how a claim was paid ─ as described on your Explanation of Benefits (EOB) ─ you can request a review. We must receive your request to review a claim within 180 days after you receive your EOB. You can either call Customer Service or submit a written request. If you suspect that payments were made for services you didn't receive - please call the Anti-Fraud Hotline at 800-596-3440.
If you prefer, you can submit a written request so you can make a copy for your records. Along with your written request, include a copy of your EOB to identify details of the disputed claim and any other documents or information that may help resolve your claim to your satisfaction. After we receive your request, we'll send you detailed information about our appeals process, including the timeframes for each step of the process. Send your request to:
LifeWise Health Plan or Oregon
P.O. Box 91059
Seattle, WA 98111-9159
Questions? Concerns? Please contact Customer Service.
Please note: Some groups may have a different contact phone number. Please confirm your contact number on the back of your ID card before calling. For more detailed information about your benefits, see your contract or Contact Us.
You can make complaints about:
You also have the right to appeal any action we take or decision we make about your coverage or services.
Learn what an Explanation of Benefits (EOB) is and how to read it.