Employer Plans Frequently Asked Questions

How do I order an ID card?
Please carry your membership card that we gave you at all times and remember to show your card when you get covered services and items. If your membership card is damaged, lost, or stolen, call Member Services right away at (812) 426-6600 TTY users may call: Indiana Relay 1-800-743-3333 Toll Free: 1-800-521-0265 and we will send you a new card. You may also E-mail Member Services

Do I need a referral to see a specialist?
When your PCP thinks that you need specialized treatment, he/she will give you a referral (approval in advance) to see a plan specialist or certain other providers. A specialist is a doctor who provides health care services for a specific disease or part of the body.
Specialists include but are not limited to such doctors as:

oncologists (who care for patients with cancer)
cardiologists (who care for patients with heart conditions),
orthopedists (who care for patients with certain bone, joint, or muscle conditions).

For some types of referrals, your PCP may need to get approval in advance from our Plan (this is called getting “prior authorization”). Examples that require approved written approval from WHP are Infertility, Plastic Surgery and Fetal Medicine and Tertiary care.

It is very important to get a referral (approval in advance) from your PCP and or WHP before you see a plan specialist or certain other providers (there are a few exceptions, including routine women’s health care that we explain later in this section).

If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. If the specialist wants you to come back for more care, check first to be sure that the referral (approval in advance) you got from your PCP and/or WHP for the first visit covers more visits to the specialist.

If there are specific specialists you want to use find out whether your PCP sends patients to these specialists. Each plan PCP has certain plan specialists they use for referrals. This means that the PCP you select may determine the specialists you may see. You may generally change your PCP at any time if you want to see a Plan specialist that your current PCP can’t refer you to.

How do I find a specialist?
You may choose a Specialist from the participating providers listed in our Provider Directory. For assistance in selecting a Specialist, please contact Member Services (call the number on the cover of this booklet). If there is a particular WHP specialist or hospital that you want to use, check first to be sure your PCP makes referrals to that specialist or uses that hospital.

Is this doctor part of the network?
The Provider Directory gives you a list of our plan providers. If you don’t have the Provider Directory, you can get a copy from Member Services. You may ask Member Services for more information about our plan providers, including their qualifications and experience. Member services can give you the most up-to-date information about our providers.

What is the difference between a PCP and a SPC?
PCP stands for Primary Care Physician and SPC is for a Specialist.

How can you switch to another PCP?
You may change your PCP for any reason, at any time. To change your PCP, call Member Services at (812) 426-6600 TTY users may call: Indiana Relay 1-800-743-3333 Toll Free: 1-800-521-0265. When you call, be sure to tell Member Services if you are seeing specialists or getting other covered services that needed your PCP’s approval (such as home health services and durable medical equipment). Member Services will help make sure that you can continue with the specialty care and other services you have been getting when you change your PCP. They will also check to be sure the PCP you want to switch to is accepting new patients. Member Services will tell you when the change to your new PCP will take effect. They will also send you a new membership card that shows the name and phone number of your new PCP.

How do I change my Address and Phone number?
Please help us keep your membership record up to date by letting Member Services know right away if there are any changes to your name, address, or phone number, or if you go into a nursing home. Also, tell Member Services about any changes in health insurance coverage you have from other sources, such as from your employer, your spouse’s employer, workers’ compensation, Medicaid, or liability claims such as claims from an automobile accident. Member Services can be reached at: (812) 426-6600 TTY users may call: Indiana Relay 1-800-743-3333 Toll Free: 1-800-521-0265 or you may e-mail Member Services.

What facility can I use for in-patient and out-patient services?
Please refer to your Provider Directory for covered facilities. If you go to a facility out of our network it will not be covered.

How can I look to see if a medication is covered under my plan?
A formulary is a list of covered drugs selected by Welborn Health Plans in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Welborn Health Plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Welborn Health Plans network pharmacy, and other plan rules are followed.

In case of an emergency am I required to go to a network hospital?
You may get covered emergency medical care whenever you need it, anywhere in the United States. Ambulance services are covered in situations where other means of transportation in the United States would endanger your health.

What is the difference between a “medical emergency” and “urgently needed care”?
The two main differences between urgently needed care and a medical emergency are in the danger to your health and your location. A “medical emergency” occurs when you reasonably believe that your health is in serious danger, whether you are in or outside the service area. “Urgently needed care” is when you need medical help for an unforeseen illness, injury, or condition, but your health is not in serious danger and you are generally outside the service area..

What services can I access without needing a referral from my pcp?
You may get the following services on your own, without a referral (approval in advance) from your PCP. You still have to pay your share of the cost as appropriate for these services.

Routine women’s health care, which includes breast exams, mammograms (x-rays of the breast), Pap tests, and pelvic exams. This care is covered without a referral from a plan provider.
Flu shot (influenza and pneumonia vaccinations). As long as you get them from a plan provider.
Emergency services, whether you get these services from plan providers or non-plan
Providers
Urgently needed care that you get from non-plan providers when you are temporarily
outside the plan’s service area. Also, urgently needed care that you get from non-plan
Chiropractic Services
Vision Services

You may get care when you are outside the service area. You will usually pay higher costs for the care because you will get your care from non-plan providers, but you won’t pay extra if you are getting care for a medical emergency. If you have questions about your medical costs when you travel, please call Member Services.

How can I get my Diabetic Supplies?
After the physician writes the prescription for the test strips, glucometer and lancets the member should present their WHP membership card at a network pharmacy or DME provider.

Commercial members without pharmacy benefits: They can get the following items at a par pharmacy or DME provider: Monitors, lancets and strips. (Benefits very)
Boonville Medical
966 N Baker Rd.
Boonville, IN 47601
(812) 897-1904

Freedom Medical East
1217 Washington Sq.
Evansville, IN 47715
(812) 471-0351‎

Freedom Medical West
2309 W Franklin St.
Evansville, IN
(812) 421-9112

HLS Home Medical
1524 W 9th St
Mt Carmel, IL 62863
(618) 262-2646

Why won’t you give any information to my family member that calls on my behalf?
HIPAA (Health Insurance Portability Act) laws prevent us from speaking to anyone, about another members protected health information (PHI) without their consent.

You must provide prior authorization to us to disclose any information about you to anyone else. You may submit a release of information form to Welborn Health Plans at anytime. The form is located below.
PHI Release Form (PDF)

I have a Power of Attorney (P.O.A.) , how do I notify Welborn Health Plans so you will release info to them?
Please submit a release of information to Welborn Health Plans along with a copy of the Power of Attorney Papers. This can be mailed to:
Welborn Health Plans
ATTN: Enrollment
101 S.E. Third Street
Evansville, IN 47708
The form is located below :
PHI Release Form (PDF)