Blue Choice Network
- National Provider Locator (outside of Iowa and South Dakota)
Select BlueCard Traditional from the Choose Your Network Dropdown menu.
- BC International Provider Locator
- Virtual Care via Doctor on Demand
Doc on Demand (pdf)
Level 1 Providers
UIHC affiliated providers that are found using XQW when searching on Wellmark, would be considered Level 1 (and Level 1 includes Washington County Hospital and their two affiliated clinics in Washington, IA as well as The Iowa Clinic, PC in Des Moines, IA).
Level 2 Providers
This level includes providers in the state of Iowa and South Dakota (and a few in surrounding states). They will be listed when you use the XQW when performing a search on Wellmark. They would be considered participating with Wellmark BCBS, both the Blue Choice (UIChoice) and the Blue Access (UISelect) network.
Level 3 Providers
would include any other providers not found when using the XQW prefix on Wellmarks website – and could be participating with BCBS or non-participating with BCBS with subject to balance billing beyond any coinsurance that may be owed.
If you are looking to see if the provider is participating with BCBS outside of the Blue Choice/Blue Access network (using XQW), you can use the XQQ prefix to do a search for those providers outside of the state of Iowa. Coverage would still be under Level 3 but any coinsurance would be applied to the Level 1 & 2 in-network out-of-pocket maximums (OPMs) of $1,700 individual and $3,400 family.
** If the providers are non-participating with BCBS, even within the state of Iowa, any coinsurance if the claim is payable will be applied to the Level 3 out-of-network OPMs of $2,000 individual and $4,000 family. Any balance billing beyond coinsurance is NOT applied to OPMs.
When a provider is non-participating with BCBS there is a chance nothing will be covered under Level 3.
The member should follow-up with Wellmark regarding any additional questions they may have.
UI Health Care providers, UI QuickCare, UI Urgent Care, Carver College of Medicine (CCOM), UI Community Medical Services Clinics (CMSC)
Pediatric Associates of UI Stead Family Children's Hospital
|Blue Choice network providers not included in Level 1. For example: Mercy of Iowa City is considered a Level 2 provider.||These providers do participate with a Blue Cross and Blue Shield Plan but are not in Level 1 or Level 2.||These providers do not participate with a Blue Cross and Blue Shield Plan.|
|Provider||Blue Cross and Blue Shield has contracts with these providers and they agree to accept payment arrangements.||Blue Cross and Blue Shield does not have contracts with these providers and they do not agree to accept payment arrangements.|
|Claim Settlement||These providers file claims for you. Claims are settled directly with these providers.||These providers are not responsible for filing claims for you. You may have to file your own claims. Claims are settled with you, not the providers.|
Participating vs. Non-Participating Providers
In Iowa, participating providers will accept payment arrangements and file claims for you with Blue Cross and Blue Shield. Payment is made directly to these providers.
Non-participating providers do not have contracts with Blue Cross and Blue Shield. They do not agree to accept payment arrangements and are not responsible for filing claims for you. Non-participating providers may charge more for health care than participating providers. Payment is made to you and you are responsible for paying the provider. Non-participating providers can bill you for the difference between what Blue Cross and Blue Shield will pay for a service and what they charge (balance billing).
When you are out of state, participating Blue Cross and Blue Shield providers will result in lower out-of-pocket costs for you and the out-of-pocket maximum for Level 1 and Level 2 will apply to these providers. If you receive care in a state that allows balance billing, using a participating Blue Cross and Blue Shield provider should result in a lower balance bill.
If you receive emergency care for covered services and cannot reasonably reach a participating provider, emergency room care received during the course of the emergency will be reimbursed as though the services were received from a participating provider. You will be billed a $100 copay, which will be waived if you are admitted.
An emergency can be considered to be a medical condition that a prudent layperson (with an average knowledge of health and medicine) could reasonably expect to result in serious jeopardy to a person’s health in the absence of immediate medical attention. The emergency services must be provided in an emergency room setting (not an urgent care center or physician’s office).
Providers at the University of Iowa Hospitals & Clinics
When care is provided at the University of Iowa Hospitals & Clinics, the individual and the provider will agree on the role medical residents will play in the individuals care. An individual may choose to have all primary health care provided by faculty members and staff physicians. When an individual is hospitalized, medical residents and medical students are an integral part of the team that provides support for treatment by the faculty and physicians on staff.
Health Care for Individuals Who Are Away from Iowa
Out of State
If you are in a state other than Iowa and require medical care, you may call Wellmark Blue Cross and Blue Shield of Iowa at (800) 810-BLUE (2583) for assistance in locating the closest participating provider in that state. You can also find providers in other states through the Wellmark website. For covered services received in a state other than Iowa there are advantages to using providers who participate with the Blue Cross and Blue Shield Plan in that state.
Out of Country
If it is necessary to receive covered services in a country other than the United States, it is advisable to contact Blue Cross and Blue Shield for assistance in locating the closest participating provider in that country.
What is a specialist?
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. (Examples: Allergist, Cardiologist, Dermatologist, Neurologist, Ophthalmologist, Orthopedics, etc.)
A non-physician specialist is a provider who has more training in a specific area of health care. (Examples: Chiropractor, Physical Therapist, Speech Pathologist, Occupational Therapist, etc.)
*NOTE: For UISelect, chiropractors, physical therapists, speech pathologists and occupational therapists’ office copay amount is the same as the office PCP copay.
Are there any age restrictions when using Doctor on Demand?
There are technically no age restrictions. There are times with certain populations where it could be more likely that Doctor on Demand would advise the person to seek in-person care due to potential complications, for example, a newborn or an elderly person with multiple health issues. In general, there are no specific age restrictions.
*NOTE: Another resource available exclusively to Wellmark members is BeWell 24/7. Health Care professionals can help answer your questions. The phone number can be found on the back of your health insurance card.
ABOUT OUR SITE:
The information presented on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions may apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. For more detailed information you may contact Wellmark Blue Cross/Blue Shield at toll-free number 800-524-9242 (TTY: 888-781-4262), Monday through Friday from 7:30 a.m. to 5:00 p.m. (Central Time). For more efficient service, please have your member ID number handy - it can be found on the front of your card.