Our quality standards for Iowa members
Your whole health is our whole point
We work hard to make sure you can get great care when you need it. We do this by:
Learn more about Quality Management
Have questions about our Quality Management program? Call us. We can talk to you about:
We can also send you information on our Quality Management program. Call 833-731-2140 (TTY 711).
Bringing you quality healthcare in IA
Did you know Wellpoint is a NCQA accredited health plan in Iowa? This means we’re committed to quality healthcare and keeping members healthy.
Case management: Helping you manage all the moving pieces
As a Wellpoint member, we offer many different types of services. Your case manager works with you and your provider to set up a plan of care. You may already be working with a case manager and know how to contact them.
If you think you need case management services or need help contacting your case manager, call us at 833-731-2140 (TTY 711).
Our case managers may also call if:
Your case manager can also help with:
If we call you, a nurse or social worker will:
How we make choices on care and services
Sometimes, we need to make choices about how we pay for care and services. This is called Utilization Management (UM).
Our UM program:
Our UM program does not:
Getting in touch with our Utilization Management staff
Some Wellpoint services and benefits need prior approval. This means your provider must ask Wellpoint to approve the services they want you to have.
Services that don’t need approval are:
Our Utilization Review team looks at approval requests. The team decides if:
What should I do if Wellpoint hasn’t approved my request?
You or your provider can ask us to take another look at services that:
We’ll let you and your provider know when we get your request.
Have questions about an approval or a denial?
Call Member Services at 833-731-2140 (TTY 711). Our Utilization Review team or your case manager can help answer your questions.
Your opinion matters
Every year, we survey our members about the benefits we offer. If you get a survey in the mail, by email or phone, please complete it. Your input helps us make your plan better.
Clinical Practice Guidelines
Clinical Practice Guidelines are rules that give providers in our network ways to treat health problems. Our Corporate Medical Advisory Committee and our Medical Policy Committee, who are two groups of specialists and external providers, approve them.
If you’d like a copy of our Clinical Practice Guidelines, either:
New technology in medicine and care
To make sure we’re using the latest medical treatment and equipment to help you feel your best, our medical director and providers review the latest:
They also look at the most up-to-date medical and scientific research. With all this data, they consider:
This work is done to help us decide if a new treatment or care should be added to your benefits.
You have rights and responsibilities
As a Wellpoint member, you have rights and responsibilities that are listed in your member handbook.
Need a handbook mailed to you?
Request a handbook via live chat with Member Services.
Your benefits and how to get medical care
Are you looking to learn more about our services and benefits? In your member handbook you can read about:
Behavioral health (mental health and substance use disorder services)
If you or a family member needs help with behavioral health issues, call Wellpoint Member Services at 833-731-2140 (TTY 711), Monday through Friday from 7:30 a.m. to 6 p.m. Central time. We’ll help you find a behavioral health specialist who can assist your needs.
You can also find a provider with our Find Care tool or by reviewing the provider directory. You don’t need a referral from your primary care provider (PCP) to visit a behavioral health specialist.
Your benefits include medically necessary services such as:
See your member handbook to learn more about your benefits.
There are some treatments and services your behavioral health specialist must ask Wellpoint to approve before you receive care.
For information about services that need preapproval, visit our Referrals and Preapprovals page or reference your member handbook.
You can also contact Member Services at 833-731-2140 (TTY 711), Monday through Friday from 7:30 a.m. to 6 p.m. Central time.
Our Notice of Privacy Practices
The notice tells you about how we may use and share your health data. It also tells you how to get this data. The notice follows the Privacy Rule set by the Health Insurance Portability and Accountability Act (HIPAA). Our Notice of Privacy Practices is in your member handbook as well as online. Live chat with a representative and let them know if you want a copy of the Notice of Privacy Practices mailed to you.