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.

Your rights and resources

Your rights and responsibilities as a health plan member

These are your rights as a health plan member:

  • You can easily get information about the organization, its services, and its healthcare practitioners and providers.
  • You can easily get information about your member rights and responsibilities.
  • We will treat you with respect. We will recognize your dignity and right to privacy.
  • You can work with your healthcare provider to decide on treatments you need.
  • You can talk honestly about the treatments that are right for your conditions, regardless of cost or benefit coverage.
  • You can make complaints or appeals about us or the care or service we provide.
  • You can recommend changes to our member rights and responsibilities policy.
  • You can choose your healthcare providers.
  • We will keep things you tell us about your health plan claims and other related information private.
  • Your healthcare and healthcare coverage information will stay protected.
  • You can review and get copies of your personal information on file.
  • You can get screening and stabilization emergency services when and where you need them. You do not need prior authorization, regardless of cost or benefits coverage. This applies if severe pain, injury, or sudden illness convinces you that your health is at great risk.
  • You can continue to get care from your specialty provider for up to 90 days or until you complete your care. This applies if you are getting treatment for a chronic or disabling condition. It applies if you are in your second or third trimester of pregnancy. It applies when you involuntarily change your healthcare plan. It applies if your provider leaves the network for any reason other than cause.

These are your responsibilities as a health plan member:

  • Give as much of the information as you can that LifeWise and its providers need in order to provide care.
  • Follow plans and instructions for care that you have agreed to with your providers.
  • Try to understand your health problems.
  • Work as much as possible with your healthcare providers to develop treatment goals you can agree on.
  • Try to keep healthy habits, such as exercising, not smoking, and eating a healthy diet.
  • Disclose relevant information. You must try to communicate clearly what you want and need.
  • Avoid knowingly spreading disease.
  • Understand your healthcare provider's obligation to provide care equally and efficiently to other patients and the community.
  • Learn about your health plan coverage and options, including all covered benefits, limitations and exclusions, and rules about the use of information.
  • Understand how to appeal coverage decisions.
  • Show respect for other patients, health workers, and health plan employees.
  • Make a good-faith effort to meet financial obligations.
  • Follow the administrative and operational procedures of your health plan and healthcare providers.
  • Report wrongdoing and fraud.

How we use your personal health information

At LifeWise, we are committed to maintaining the confidentiality of your medical and financial information. The Notice of Privacy Practices informs you about how we may collect, use and disclose your personal information and your rights regarding that information.

Notice of Privacy Practices
Aviso de Practicas de Privacidad

Language assistance

To get language assistance, contact Customer Service.

TDD/TTY services

Our TDD/TTY number for deaf, hard of hearing, or speech-impaired members is 711.

How and when to send us a request for reimbursement

When you receive care from providers in the network, they will process your claims (requests for payment) directly with us. This means you don't need to manage any paperwork. However, if you receive care from a non-network provider, you might have to pay the doctor, dentist or other provider for the service and then file a claim with us for reimbursement.

To file a claim for reimbursement:

  1. Complete and sign the form for your type of plan.
  2. Staple an itemized bill from the provider to the form.
  3. Mail your claim to the address shown on the form. See your benefit booklet for your health plan for more details on filing claims.

See your benefit booklet for more details on filing claims.

Request a claim review

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 contact us or submit a written request. If you suspect that payments were made for services you didn't receive, please call the Fraud Hotline at 800-596-3440.

Submit a written request

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 explanation of benefits (EOB) to identify details of the disputed claim. You may also include 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:

Individual & Family Claims

  • LifeWise Health Plan of Washington
    PO Box 21552
    Eagan, MN 55121-9159

Employer-based Claims

  • LifeWise Health Plan of Washington
    PO Box 91059
    Seattle, WA 98111-9159
Questions or concerns?

Contact us

Note: Some groups may have a separate contact phone number. Confirm your contact number on the back of your member ID card before calling. For more detailed information about your benefits, see your contract or contact us.

How to submit a complaint, your right to appeal, and availability of independent external review

To submit a complaint, choose the appropriate member form:

Member appeal and authorization form

Formulario de apelación del miembro

Independent Review Organization (IRO) 

Member complaint form 

Complaint and appeal rights

Subjects can include the following:

  • 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.

Understanding your ID card

Always carry your LifeWise member ID card and show it to doctors, other providers, and pharmacists whenever you need care or prescriptions. Find out what each item on your ID card means.

Understanding your explanation of benefits

Each time LifeWise processes a claim submitted by you or your healthcare provider, we describe 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.

Understand your explanation of benefits (EOBs)      Sign into your account to get paperless EOBs

Need help finding what you’re looking for?

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