FAQS

Frequently Asked Questions

Get helpful answers to popular questions about LifeWise, plans, benefits, and resources.

Getting started

When will I get my ID card?

You will get your digital ID card shortly after we receive your first payment from you or your employer. We will only mail a hardcopy of your ID card to you if you request it.

Do I need an online account?

An online account will help you simplify and streamline the management of your plan and care, at any time and from anywhere. With an online account, you can get quick access to your benefit information, view your claims, and make one-time or recurring payments, if needed.

Register for an online account

I want to go paperless. How do I get my explanation of benefits, invoices, ID card electronically?

Sign in or create an online account and follow the detailed instructions on the homepage. Or call customer service 800-817-3056 and speak to someone directly about opting into paperless today.

As a returning member with an online account, do I need to set up another one?

No. If you previously created an online account for your LifeWise plan, you do not need to create another one. You can continue to use the same online account.

How do I change my designated primary care provider (PCP)?

To change your PCP, call customer service at 800-817-3056.

Billing

I recently enrolled in a LifeWise health plan. How do I make my first payment?

We will mail your first monthly bill, also called an invoice, as soon as we receive your enrollment. Your invoice will include your payment options and your subscriber ID, which you’ll need to make payments online or by phone.

The quickest way to make your first payment is to pay by phone or create an online account.

How do I pay my bill?

You have four options!

Pay online, one-time, or autopay

  1. Sign in to your online account. (Create an account if you have not yet done so.)
  2. Once signed in, use the payment buttons to make a one-time payment or to manage recurring automatic payments (autopay). Make sure to enable pop-ups or the payment system will not function properly.

Automatic payments must be set up by the 23rd of the month in order to draft the following month's premium payment on the 28th.

To update your autopay payment method, sign in to your account. Select the "Manage Recurring Payments" button on the right side of the page, and then select "EDIT" on your existing autopay to update or add a new payment method. Remember, only the subscriber on your plan can set up or update autopay.

Pay by check

  1. Write your member ID on your check.
  2. Detach the payment coupon portion of your invoice (at the bottom of page 1) and include it with your check. Use the enclosed envelope.
  3. Mail payments to:
    LifeWise Health Plan of Washington Member Premiums
    PO Box 840535
    Los Angeles, CA 90084-0535

Pay by phone

Call 866-327-8016 to use our automated payment system. Have your subscriber ID handy. You can also call the customer service number on the back of your ID card. Please follow the phone prompts to make a payment. (Our customer service representatives cannot take your payment.)

Pay with your bank’s bill pay system

  1. Access your bank’s online bill pay system. Have your subscriber ID handy.
  2. When setting up your bank bill pay, select LifeWise Health Plan of Washington.
  3. When prompted, select this exact address:
    LifeWise Health Plan of Washington
    PO Box 840535
    Los Angeles, CA 90084-0535

Important: This address must be selected in order for your payment to be successfully processed.

If you were previously advised that bank bill pay was not available, please know that you can now use bank bill pay to pay your monthly premium if your bank offers this service.

Who can and cannot pay my health plan bill?

There are some restrictions on who can pay your monthly bill from LifeWise.
LifeWise cannot accept payment from a sole proprietor or business account—even if it’s your own. We also cannot take payment from an employer, a charity, or a healthcare provider for individual health plans, except as required by law. These payments will be returned, and you will need to resubmit payment using an accepted method.

The following people or organizations can pay your monthly bill:

  • You – through a personal account, not a business account.
  • A member of your family, such as a spouse or parent.
  • An Indian tribe, tribal organization, or urban Indian organization.
  • State and federal government programs and their grantees.
  • Ryan White HIV/AIDS Programs (and their community-based organizations like Evergreen Health Program).
  • LyfeBank.
  • Pierce County Project Access (if you purchased your plan through WA Healthplanfinder).

Failure to comply with these guidelines could leave you open to IRS penalties; contact your tax or legal advisor for more information. Your payment will be returned to you, and you’ll need to find another way to pay your bill. If you're unable to pay with an accepted method, your plan could be canceled due to non-payment. If your plan is canceled, you may not be able to enroll again until the next open enrollment period.

What happens if I miss a payment?

Please note: We are currently complying with recent requirements from our regulatory entities regarding grace periods. Current information may differ from the information you see here.

  • Your payment is due on the first of each month.
  • If you receive a subsidy to help pay for your plan, you have a 90-day grace period.
  • Your coverage is good through the last day of the month for which Premera receives a subsidy payment. You may not have access to your benefits during months two and three of your grace period.
  • If you do not receive a subsidy, including off-exchange plans, you have a 30-day grace period.
  • If you voluntarily cancel your plan, you may not be able to enroll in another plan until the next open enrollment period, unless you have a qualifying life event.
  • If you have an unpaid health plan premium and choose to reenroll with LifeWise, you may have to pay unpaid health plan premiums from the past 12 months.

My income recently changed, which impacts my ability to pay my monthly bill. What are my options?

  • Based on your current income, you may qualify for an advance premium tax credit (subsidy) to help pay your monthly premium. You may also be eligible for low-cost or no-cost coverage from the state.
  • Start by reporting your change in income to Washington Healthplanfinder or by calling their customer support at 855-923-4633.

How do I remove pop-up blockers?

To remove pop-up blockers, please refer to the browser you’re currently using and follow the steps to disable pop-up blockers:

iPhone or iPad IOS

  1. Open the Settings app in iOS and go to Safari.
  2. Under the General Safari settings, toggle the switch next to Block Pop-ups to select the OFF position. This will disable the pop-up blocker.

Chrome

  1. Click the Chrome menu button.
    Note: The button is on the upper-right of the browser and is indicated by three dots.
  2. Select Settings.
  3. At the bottom of the page, click Advanced.
    Note: If Advanced is already selected, additional options will be available below it.
  4. Under Privacy and security, click Site settings.
  5. Click Pop-ups and redirects.
  6. Click Blocked (recommended).
    Note: After the pop-up blocker is disabled, the option will show as enabled and display Allowed.

Safari

  1. Open Settings.
  2. Scroll down and select Safari.
  3. Under General, you'll find the toggle switch for Block Pop-ups. Use it to enable or disable pop-up blocking.
  4. Go back to Safari and reload the website that requested pop-up access. It should now be able to open a new pop-up window in Safari and display the content.

Firefox

  1. Click the Open menu button (three bars) in the upper-right corner.
  2. Click Options or Preferences.
  3. Select Privacy & Security on the left.
  4. Uncheck Block Pop-up windows to disable the pop-up blocker.
  5. Close and relaunch Firefox

Primary care providers

Why was I assigned a primary care provider (PCP)?

We want you to get the most out of your benefits. If your plan has a PCP copay, you’ll pay less when you see your designated PCP. Even if your plan does not offer a PCP copay, having an assigned PCP can help you get care quickly when needed since you’ll know where to go.

Why was I assigned a PCP at this point in the year?

We wanted to allow time for customers to select their PCPs. Staying healthy and getting care is more important than ever, so we’ve assigned PCPs to those who have not yet selected a PCP.

What are the benefits of having a PCP?

  • It saves you money. On most plans, you’ll get a lower copay when you see your designated PCP (HSA plans subject to deductible and coinsurance).
  • It saves you time. When you have a PCP or primary care clinic as your medical “home base,” you know exactly who to call—no searching online frantically for an available clinic or urgent care center.
  • They’re very good at what they do. PCPs are experts in a broad range of health care services especially when it comes to preventive care, chronic diseases, and overall wellness. Providers can provide one-stop preventive care through proactive health screenings and lifestyle plans so you can enjoy your best life.
  • You’ll have a trusted health partner to guide you. A PCP is by your side throughout your healthcare journey. This close relationship allows your PCP to search for trends in your health history and identify health risks early on before they become more serious.
  • Fewer hospital and ER visits. Studies show that people who see a PCP regularly are less likely to be hospitalized for serious health issues and have fewer trips to the ER during their lifetime.

Why was my PCP reassigned?

If you’ve been reassigned to a new PCP, it means your previous provider is no longer in network or no longer practicing medicine. We do our best to incorporate historical data in our assignment and may not always accurately capture a previous PCP you’ve seen before.

How do I view or change my PCP?

Sign in to your account and go to the My Account menu, then Primary Care Provider, to see your designated PCP. If you would like to change your PCP, please call customer service 800-817-3056.

How do I schedule an appointment with my new PCP?

Once you have identified your assigned PCP, get started by calling your PCP’s office. Let them know if you are a new or returning patient, and they will work with you to schedule an appointment based on your availability.

What should I do if my assigned PCP is not accepting new patients?

PCP availability can change. If your assigned PCP is not accepting new patients, you can search for PCPs who are accepting new patients in our secure portal. Sign in to your account, go to the Benefits menu, and select Find a Doctor > Find a doctor.

Do I need a referral from my PCP to see a specialist?

No. You can see any in-network specialist without a referral.

Do I need to see a specific PCP at a clinic to get the PCP copay, or can I see any PCP there?

If your plan has a PCP copay, you can see any PCP at the clinic listed and receive the PCP copay.

Can I pay a virtual visit to a new PCP?

It depends on the provider. Some PCPs offer virtual visits via phone or video. You can ask when you call to make an appointment.

Preapprovals

What services do not require preapprovals?

  • Hospital admission for prenatal, childbirth, and newborn care.
  • Emergency admission to hospital.
  • Office visits to a primary care doctor, family doctor, or specialist.

Can in-network doctors request preapprovals on my behalf?

Yes. Providers who are in the LifeWise network are familiar with the process for securing preapproval. They can contact LifeWise on your behalf. In-network doctors have all of the medical information needed to ask that your medical service be reviewed and approved for coverage. Always ask your healthcare provider about requesting preapproval before you schedule a service or procedure.

What if my doctor doesn’t request a preapproval?

If your doctor gives you a service that requires preapproval without requesting it, you may have to pay part or all of the cost, above your usual cost shares. For complete information about your plan's medical benefits and preapproval requirements, read or download your benefit booklet.

Do some drug prescriptions require preapproval?

Yes. Use our Covered drug lists to see if a drug falls into one of four Prior Authorization categories: Formulary Exception (non-formulary), Quantity Limit, Step Therapy, and Preapproval.

To request a prior authorization review, the pharmacy or the provider must contact our pharmacy services center at 888-261-1756or submit a pharmacy prior authorization request fax form for a specific drug. Sometimes a pharmacy can also do a one-time override for urgently needed medication.

Learn more about emergency overrides

Note: For drug review requirements specific to a customer's plan, Members can log in to My Rx Choices via MyPharmacyPlus™ to view drug review requirements specific to their plan.

Apple Health (Medicaid)

Who can get Apple Health?

Apple Health is available to those under a certain income level. You must also be a citizen or legal resident of five years under the age of 65. You can find all of the eligibility requirements on Washington Health Care Authority's website.

How do I know if I’ve been impacted by the recent Apple Health Medicaid redetermination?

The Washington Health Care Authority has started reaching out to people who are losing their coverage to notify them of their options. Letters will be sent asking recipients to get in touch to find out if they still qualify for Medicaid, also known as Apple Health in Washington state.

I no longer have Apple Health. Can I enroll in a LifeWise health plan during a Special Enrollment period (SEP)?

Yes. If you recently became ineligible for Apple Health or Medicaid due to a redetermination, you likely qualify for the SEP period during which you can enroll in a LifeWise plan. Special enrollment periods allow individuals and families to buy health insurance outside of open enrollment. LifeWise offers Cascade Care plans that are designed by the Washington Health Benefit Exchange to provide the benefits you need while keeping your out-of-pocket costs down.

Why is my Apple Health plan being terminated?

The Department of Health and Human Services (HHS), a federal agency, determined COVID-19 to be a public health emergency (PHE) starting in January 2020. HHS indicated the PHE would end on May 11, 2023. The Families First Coronavirus Response Act (FFCRA) allowed most Apple Health clients to continue receiving Apple Health coverage for the duration of the PHE, also known as “continuous enrollment.”


Certain eligibility and verification factors were also relaxed. Apple Health no longer terminated clients who failed to renew or complete an eligibility review. If a client’s eligibility is terminated for any other reason, HCA and DSHS reopened coverage, unless the client passed away or moved out of state. New changes in December 2022, Congress signed into law the Consolidated Appropriation Act, of 2023, which separates the continuous enrollment requirement from the PHE. This requires Washington state to begin redeterminations on 04/01/2023, even if the PHE continues.

When do terminations start?

In WA state, beginning 4/01/2023, WA state staff will begin requesting verification of income, resources, and other eligibility factors, unless staff can verify through electronic data sources. Some terminations resume on 4/30/2023, but more likely on 5/31/2023.

Why should I consider LifeWise Health Plan of Washington for my individual healthcare needs?

LifeWise is part of a family of health plans with deep roots in Washington state. We care for more than 2.2 million people. We also have an A credit rating, so you know you can trust us with your financial investment in your health.


We are committed to caring for communities in Washington state and providing more access to affordable healthcare. We deliver low-cost options, virtual care so you can get the care you need without leaving your home, and access to primary care, urgent care, mental health therapy and substance use disorder treatment from wherever you feel the safest and most comfortable.


Choosing the right health plan for you and your family can be a challenging experience, especially when you don’t have an employer kicking in for the monthly premium payments or a human resources team to answer your questions. At LifeWise, you’ll have us on your team. Our goal is to give you the confidence and certainty you need to make the right healthcare decisions.

Are LifeWise plans affordable?

LifeWise offers Cascade Care plans across most of Washington state. Cascade Care aims to increase the availability of quality, affordable health coverage in the individual market, and ensure residents in every Washington county have a choice of a qualified health plan. Cascade Care plans offer more coverage and ways to save than non-Cascade Care plans. They are available through Washington Healthplanfinder.

What is Cascade Care Select?

Cascade Care Select offers a new way to save on premiums. LifeWise offers Cascade Care Select in 19 counties, including Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Island, Klickitat, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Spokane, Thurston, Wahkiakum, Whatcom, and Yakima. These plans are designed by the Washington Health Benefit Exchange. Many services are covered at a flat-dollar co-pay, making these plans a good choice if you want to know upfront what you will pay for a service.

Does a LifeWise plan include access to Kinwell Clinics?

Yes. Kinwell Clinics are located across Washington state and are exclusively available to LifeWise and Premera Blue Cross members. Kinwell offers primary care, virtual care, and behavioral health. Find a Kinwell clinic near you.

Where can I find support to answer questions about my eligibility?

Support is easy to find online and over the phone through LifeWise of Washington at: 800-817-3056. Our customer service representatives are available between 8:00 a.m. – 6:00 p.m. PST, Monday through Friday. Our knowledgeable team can help answer questions and explore your plan options.


You can also reach out to Washington Healthplanfinder at: 855-923-4633 or http://www.wahealthplanfinder.org/. They have enrollment partners statewide ready to assist you.

Digital health messages

What are digital health messages and how do I sign up?

Digital health messages are a new way for you to interact with LifeWise. It lets you receive information in a manner that many people prefer these days: a text-based messaging system. Every time you receive a new text message from us, it takes you to your own personalized and secure communication channel.


This complimentary service helps you stay informed and aware of healthcare updates. We will notify you with a text when you have messages that need your attention. After authenticating once with your date of birth, you'll have secure access to personalized care information quickly and easily from your phone.


Some messages may include member benefits, tips to save money on your health care and friendly reminders about your health – like when it’s time for an annual visit or screenings and much more. LifeWise will only notify you when there are helpful messages related to your healthcare. Typically, you will receive 1-2 messages per month. This feed is for private, one-to-one communications. Messages from LifeWise will always come from "51987.”


While we offer this service at no charge, standard message and data rates may apply depending on your mobile carrier plan. You can opt out of receiving notifications at any time by going to the most recent message you received, and text STOP.


Sign up here

When signing up, why do I need to provide my date of birth?

For verification purposes. When you receive your first text message and click on the link to access your personalized feed, you will be asked to verify yourself by entering your date of birth. This request will be asked only once. If you get logged out of the system by clearing your internet cache or for other reasons, we will ask you to re-authenticate by providing your date of birth.

Is it safe to receive these text messages?

Yes. Digital health messages are a HIPAA-compliant communication platform meant to allow you to have peace of mind that your information is secure all while receiving information in a timely more effective manner given your preference. We've partnered with a third party to provide these updates.

For how long is the link active?

The link is active for 72 hours upon receipt of the text message. If you access the link after this timeframe, you may receive a notification that your auth link has expired. You can click the resend auth link button at the bottom of the screen, and you will receive a new text message with a new, personalized link to access your message feed.

Can I access my messages through a non-smartphone?

No. The link can only be accessed on a smart device that is linked to a mobile number and can receive SMS.

Policies and procedures

Where can I find more information about costs and covered benefits and services?

To learn more about the costs you may have to pay, refer to My LifeWise Plan Information, your benefit booklet or contact Customer Service.


To learn more about your plan benefits and services, refer to My LifeWise Plan Information, Summary of Benefits and Coverage, your member booklet, or contact Customer Service.


View summary of benefits and coverage

Are there limitations and exclusions to my LifeWise health plan?

Yes. Our 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.

  • All medical and hospital services not specifically covered in, or that are limited or excluded by your benefit plan, including costs of services before coverage begins and after coverage terminates.
  • Cosmetic surgery, except as specifically described in your member benefit booklet.
  • Custodial care.
  • Experimental and investigational procedures, services, and drugs, Implantable drugs (non-contraceptive related), and certain injectable drugs, including injectable infertility drugs.
  • Infertility services including donor egg retrieval, artificial insemination, and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, and other related services, unless specifically listed as covered in your plan documents.
  • Non-medically necessary services or supplies.
  • Radial keratotomy or related procedures.
  • Reversal of sterilization.
  • Services for the treatment of sexual dysfunction or inadequacies including therapy, supplies, or counseling.
  • Special or private duty nursing.

How am I protected from surprise costs?

First, when you visit a provider, make sure that everyone who participates in your care is in your plan network, including labs or tests.

Next, know your rights and protections against surprise medical bills or balance billing.

As of January 1, 2020, members of individual and family plans in Washington have the protection of the Washington Balance Billing Act. Beginning January 1, 2022, you have federal rights and protections against surprise medical bills or balance billing.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

Learn about "balance billing”— sometimes called, “surprise billing.”

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn't in your health plan's network.

"Out-of-network" describes providers and facilities that haven't signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
Insurers are required to tell you, via their websites or on request, which providers, hospitals, and facilities are in their networks. Hospitals, surgical facilities, and providers must tell you which provider networks they participate in on their website or on request.

You are protected from balance billing for emergency services.

If you have an emergency medical condition, mental health or substance use disorder condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan's in-network cost-sharing amount (such as copayments and coinsurance). You can't be balance billed for these emergency services. This includes care you receive in a hospital and in facilities that provide crisis services to people experiencing a mental health or substance use disorder emergency. You can't be billed for these emergency services, including services you may get after you're in stable condition.

You are also protected from balance billing for certain services at an in-network hospital or ambulatory surgical center.

When you get services from an in-network hospital or ambulatory surgical center, certain providers at that center may be out-of-network. In these cases, the most that those providers may bill you is your plan's in-network cost-sharing amount. You also aren't required to get care out-of-network. You can choose a provider or facility in your plan's network.

When can you be asked to waive your protections from balance billing? Health care providers, including hospitals and air ambulance providers, can never require you to give up your protections from balance billing. If you have coverage through a self-funded group health plan, in some limited situations, a provider can ask you to consent to waive your balance billing protections, but you are never required to give your consent. Please contact your employer or health plan for more information.

When balance billing isn't allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles) that you would pay if the provider or facility was in-network. Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
  • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
  • Cover emergency services by out-of-network providers.
  • Base what you owe the provider or facility (cost-sharing) on what it would pay an in‑network provider or facility and show that amount in your explanation of benefits.
  • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you've been wrongly billed, you may:
File a complaint with the federal government
By phone: 800-985-3059
Online: https://www.cms.gov/nosurprises/consumers/

File a complaint with the Washington state Office of the Insurance Commissioner
By phone: 800-562-6900
Online: https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status

For more information about your rights, visit:
https://www.cms.gov/nosurprises
https://www.insurance.wa.gov/what-consumers-need-know-about-surprise-or-balance-billing

If you ever get a bill or claim that doesn't seem right, be sure to contact us and we'll look at it with you.

How do I find a doctor or other providers to get primary care?

LifeWise wants to make sure you are getting the care you need. Annual check-ups can identify problems early, before they become more serious. Regular visits with your doctor also allow you to discuss any health concerns you may have including more complex health conditions you may have.


You may seek specialty care and behavioral healthcare from in-network or out-of-network providers. Be sure to talk with your primary care provider about your preferences. Depending on your plan, you may need a referral from your primary care provider in order to access specialty care. Refer to your member benefit booklet for details.


Participating in-network providers and facilities are listed in Find a Doctor. Sign in to see providers in your network. Certain nonemergency hospitals and other medical services require preapproval from LifeWise. Contact us if you have difficulties finding a provider or have other questions.


Note: If you are enrolled in an EPO plan, in most cases you are only covered for services from in-network providers. Sign into your online account to use Find a Doctor or refer to your member benefit booklet for details.

How do I find specialist, behavioral health, or hospital care resources?

Members may seek specialty care and behavioral healthcare from in-network or out-of-network providers. Be sure to talk with your primary care provider about your preferences. Depending on your plan, you may need a referral from your primary care provider in order to access specialty care. Refer to your member benefit booklet for details.


Participating in-network providers and facilities are listed in our online Find a Doctor directory. Sign into your online account to find providers contracted with your specific plan. Certain non-emergency hospitals and other medical services require preapproval from LifeWise. Customer Service can assist you with the directory or help you locate a practitioner or facility within a specific geographic area.


Please note: If you are enrolled on an EPO plan, in most cases you are only covered for services from in-network providers. Sign into your online account and refer to your member benefit booklet for details.


After-office-hours or emergency care
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 NurseLine
Call 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.

Conditions that can be dealt with in an urgent care facility:

  • Ear infections
  • Low fever or mild flu symptoms
  • Minor rashes, cuts, bites, and sprains

Life Threatening
Call 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:

  • Suspected heart attacks
  • Strokes
  • Broken bones

Out-of-area care and benefit coverage
If you have a LifeWise plan and travel outside the area covered by the primary network, you only have coverage for emergencies. If you are on a LifeWise grandfathered plan your out-of-area coverage is different. Check your member booklet for details.

Where can I learn more about pharmacy benefits, prescriptions, and orders by mail?

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 plan
View drugs subject to Preservice review

View your drug list and see which drugs have limitations to prescribing or access:
Search drug lists
Visit Express Scripts to view your personalized pharmacy benefits

Learn how to obtain restricted pharmaceuticals:
Use drug lists to learn which drugs have restrictions, quantity limits and step therapy
Visit Express Scripts to find your copay for a restricted prescription
Learn about prescription mail-order

Save money with generics
Generic drugs have been proven to be as effective and safe as brand-name drugs. They may come in different shapes and colors than their brand-name equivalent, but they contain the same active ingredients, and are available in the same strength and dosage. On average, a member can save up to $222 a year by using a generic drug instead of a brand-name drug. Learn more about the Food and Drug Administration's (FDA) approved drugs.

Before filling a prescription, always ask your provider/pharmacist:

  • Is this drug available as a generic?
  • Is there a low-cost generic available within this group of drugs that works the same?

What is the Utilization Management Program and goal?

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.

What is your policy on prohibiting financial incentives?

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, and any people or organizations we hire to review requests.

What is your Quality Program all about?

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.

How do new technologies become covered services?

Teams of doctors, pharmacists, and nurses review new drugs and medical services. The Medical Policy Committee reviews new technology and other medical or surgery services. The Pharmacy and Therapeutics Committee reviews new drugs and some therapies. These committees decide if a new drug or service will be covered. Their decisions are based on sound published medical studies. Their decisions help protect against the use of treatments that are not proven or not safe.

Where can I find more health and 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 provide useful tools to help you talk with your doctor about care and medications.

Check out Five Steps to Safer Healthcare 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 The10 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:

  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do this?

Learn more by visiting: Institute for Healthcare Improvement.

5 Steps to safer care
Agency for Healthcare Research and Quality.

How do I access my personal health records?

To request certain records containing your personal information complete the request for Inspection of Records form. To share your personal records you can use the Information Release Form—Give someone permission to obtain and discuss your personal and health information, including sensitive information such as substance abuse, reproductive health, and mental health. You can also authorize members on your plan to see your sensitive information on lifewise.com or ConnectYourCare (medical funding account).

How do I get support for a chronic condition?

LifeWise offers help to support to our members, their spouses/domestic partners, and dependents who are enrolled in a LifeWise plan and are diagnosed with a chronic condition such as asthma, coronary artery disease, heart failure, chronic obstructive pulmonary disease, diabetes, or depression. Personal Health Support encourages healthy lifestyle changes and helps develop self-management strategies for better health. This program is available at no cost to you.

Tools and resources
Participants have access to a personal health support team of registered nurses, certified dietitians, and licensed mental health professionals with expertise in chronic condition management. The program also includes:

  • Regular, pre-scheduled telephone sessions with a care advisor to develop a personal care strategy. These calls are meant to help monitor symptoms, better manage the health condition, promote regular exercise, and improve nutrition.
  • Educational materials, health monitoring tools, and newsletters developed for specific conditions.
  • Help for understanding tests and prescription medications.

Participation is voluntary, and you can withdraw at any time.

3 ways to join

  • LifeWise identifies you as someone who can benefit from the program, based on your previous claims and reaches out to you directly.
  • Your doctor or another healthcare provider refers you to the program and LifeWise contacts you.
  • You can call LifeWise at 1-800-817-3056 (711 TTY/TDD for the hearing impaired).

NOTE: For benefit and claims questions, please either contact the Customer Service number on the back of your insurance card or you may also email from your Secure Inbox.

More information

Diabetes
diabetes.org
cdc.gov
nih.gov
win211.org

Asthma
lung.org
nhlbi.nih.gov
cdc.gov
win211.org

COPD
lung.org
goldcopd.org
nhlbi.nih.gov
cdc.gov
win211.org

Coronary Artery Disease (CAD) and Heart Failure
heart.org
nhlbi.nih.gov
win211.org

How do I get help from a care advisor?

Personal Health view offers support to help you or a family member with serious health problems. With this service, a care advisor will help you with any concerns you have with your health or care. This service is voluntary and free as part of your health plan.

Your Personal Approach to Health (PATH)

LifeWise Health Plan of Washington is committed to helping you get healthy and stay well. Care Advising services are offered as part of your PATH, if you need additional support managing your health.

Care Advising services are included in your plan at no additional cost.

To enroll or get more information, call 800-817-3056. TTY: 711

How do I get language assistance from LifeWise?

To get language assistance, contact Customer Service.

TDD/TTY services
Our TDD/TTY number for deaf or hard of hearing members is 711.

How do I submit a complaint, exercise my right to appeal, or request an independent external review?

You can make complaints about:

  • The care or service we provide.
  • The quality or availability of a healthcare service.
  • The care or service you get from any providers in our network.

You also have the right to appeal any action we take or decision we make about your coverage or services.

Get additional information about how to file a complaint, appeal, or request an external review.

Can you help me to understand my explanation of benefits better?

Sure. Each time LifeWise processes a claim submitted by you or your healthcare provider, we explain how we processed it in the form of an explanation of benefits (EOB).

The EOB is not a bill. It simply explains how your benefits were applied to that claim. It includes the date you received the service, the amount billed, the amount covered, the amount we paid and any balance you're responsible for paying the provider. It also tells you how much has been credited toward any required deductible.

Each time you receive an EOB, review it closely and compare it to the receipt or statement from the provider.

Need help finding what you’re looking for?

Contact a LifeWise customer service representative. We’re here to help.