Health care under the UIChoice plan is available through levels 1, 2, and 3 providers.

You do not need to pick a plan level before receiving care from a provider. The lower the provider level you visit, the lower out-of-pocket costs for the UISelect member.

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UIChoice Provider Levels

Level 1 Providers

Level 1 providers under UIChoice include the University of Iowa Hospital and affiliated clinics, UI Urgent Care, UI QuickCare, Washington County Hospitals and Clinics, and The Iowa Clinic in Des Moines.

When searching on the Wellmark website for providers, you will use the prefix "XQW."

Providers at the University of Iowa Hospitals & Clinics
Medical residents and medical students are an integral part of the team that supports treatment by the faculty and physicians on staff. When care is provided at the University of Iowa Hospital and Clinics, the individual and the provider will agree on the medical residents' role in their care. An individual may choose to have all primary health care provided by faculty members and staff physicians.

Level 2 Providers

This level includes providers in 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

This level would include any other providers not found when using the XQW prefix on the Wellmarks website – and could be participating with BCBS or non-participating with BCBS subject to balance billing beyond any coinsurance that the member may owe.

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 search 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, nothing will be covered under Level 3.  

The member should follow up with Wellmark regarding any additional questions.

Care Providers by Level

Provider Category
 
Level 1
Providers
 
Level 2
Providers
 
Level 3
Participating Providers
Level 3
Non-Participating
Providers
Description

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

Washington County Hospitals & Clinics and The Iowa Clinic, PC, Des Moines

Blue Choice network providers are not included in Level 1. For example, Mercy of Iowa City is considered a Level 2 provider.  These providers 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 have contracts with these providers, and they agree to accept payment arrangements. Blue Cross and Blue Shield do 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 claims. Claims are settled with you, not the providers.

Additional Provider Information and Definitions

A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat specific 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.) 

There are times with specific 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 older adult with multiple health issues. However, 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. In addition, the member can find the phone number on their health insurance card.

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 from Wellmark, 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, using a participating Blue Cross and Blue Shield provider 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. In addition, if you receive care in a state that allows balance billing, using a participating Blue Cross and Blue Shield provider should lower the balance bill.

If you receive emergency care for covered services and cannot reasonably reach a participating provider, emergency room care received during the emergency will be reimbursed as though the member obtained the services from a participating provider. In addition, you will be billed a $100 copay, which will be waived if you are admitted.

An emergency is 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. Therefore, the emergency services must be provided to the member in an emergency room setting (not an urgent care center or physician’s office).

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  

Suppose it is necessary to receive covered services in a country other than the United States. In that case, it is advisable to contact Blue Cross and Blue Shield for assistance in locating the closest participating provider in that country.

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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.