FAQS
Frequently Asked Questions
Get helpful answers to popular questions about LifeWise, plans, benefits, and resources.
Explore individual or employer-based health plans and discover the LifeWise difference.
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Learn how to set up, sign in, and use your LifeWise account and explore tools and resources for understanding and using your benefits.
FAQS
Get helpful answers to popular questions about LifeWise, plans, benefits, and resources.
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.
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.
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.
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.
To change your PCP, call customer service at 800-817-3056.
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.
You have four options!
Pay online, one-time, or autopay
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
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
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.
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:
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.
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.
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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.
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.
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.
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.
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.
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.
No. You can see any in-network specialist without a referral.
If your plan has a PCP copay, you can see any PCP at the clinic listed and receive the PCP copay.
It depends on the provider. Some PCPs offer virtual visits via phone or video. You can ask when you call to make an appointment.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
No. The link can only be accessed on a smart device that is linked to a mobile number and can receive SMS.
These are your rights as a health plan member:
These are your responsibilities as a health plan member:
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.
To get language assistance, contact Customer Service.
Our TDD/TTY number for deaf, hard of hearing, or speech-impaired members is 711.
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:
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 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.
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
Employer-based Claims
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.
To submit a complaint, choose the appropriate member form:
Member appeal and authorization form
Formulario de apelación del miembro
Independent Review Organization (IRO)
Subjects can include the following:
You also have the right to appeal any action we take or decision we make about your coverage or services.
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.
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.
Contact a LifeWise customer service representative. We’re here to help.