Traveling? You've got coverage
Traveling and find you need health care? Members of WellFirst Health — Provided by SSM Health Plan — are covered for urgent and emergency care worldwide. Regardless of where you travel, you don’t need to take health care coverage worries with you on vacation. We have you covered.
You do not need a referral or prior authorization for urgent or emergency services — no matter where you travel:
- We cover urgent and emergency services while you are outside of our service area (subject to member policy copays, coinsurance, deductibles and maximum allowable fees).
- Out-of-network services are from doctors, hospitals and other health care professionals that have not contracted with your plan. A health care professional who is out of your plan network can set a higher cost for a service than professionals who are in your health plan network.
- Depending on the health care professional, the service could cost you more or not be paid for at all by your plan. Charging you this extra amount is called balance billing.
Care received by an out-of-network provider is covered under these circumstances:
- Emergency Services received from an out-of-network provider if the member cannot reach an in-network provider.
- All follow-up care should be done by a plan provider. If you are out of the area and unable to see a plan provider, call your primary care provider for a referral to an out-of-network provider. These services require our approval.
URGENT CARE SERVICES
- If you receive out-of-network urgent care services, you are covered by your plan for charges up to the maximum allowable fee. If there is a difference between the maximum allowable fee and what the out-of-network provider bills, you may have to pay the difference.
- Call our Customer Care Center at 866-514-4194 if you have questions about the maximum allowable fee.
If you require urgent or emergency care outside the service area and are unable to get to a plan provider, go to the nearest urgent care or emergency center for treatment. It is important to notify us as soon as possible by calling the Customer Care Center.
See more information about surprise balance billing and the No Surprises Act.
In most cases, claims are submitted directly to us by the providers or clinics. On occasion, if you’re traveling out of the area or have a college-age dependent, for example, it may be necessary for you to submit a claim for reimbursement. When submitting the claim, be sure to follow these guidelines:
- Send an itemized bill from the provider of service. If services were received outside of the U.S., you will need to submit the original bill along with an itemized bill that has been translated into English and indicate the appropriate currency exchange rate at the time the services were received.
- Send the bill within 60 days after the services are received to: WellFirst Health — Provided by SSM Health Plan, Attn: Claims Department, P.O. Box 56099, Madison, WI 53705.
If you have other health coverage that is the primary payer, you will need to send the EOB to us or your health care provider.
Questions? Contact us at 866-514-4194 (TTY: 711) or the number on the back of your member ID card.