Meet Your Wespath Care Coordinators: Simplifying Your Health Care Journey, One Call at a Time

This year, you may have noticed a new phone number on your HealthFlex ID card for Care Coordination. Care Coordination is a new service in partnership with Quantum Health that is included with your HealthFlex coverage to make your health care journey simpler. With one phone call (no phone tree or complicated menu), you’re connected to a dedicated team of nurses, claims specialists and benefits experts to get your health care questions answered.

Wespath Care Coordinators can help you with a variety of health care topics, including finding in-network providers; understanding claims, billing and benefits; helping you save on out-of-pocket costs; reviewing your care options and verifying coverage; and replacing ID cards. Primary participants can easily access their Care Coordination account through Benefits Access, or by calling (833) 762-0876 Monday-Friday, 8:30 a.m.- 10:00 p.m., Eastern time.

We sat down with a Wespath Care Coordinator to learn more about this service and how it can help you:

Can you tell us a little about yourself and your role as a Wespath Care Coordinator?

What is your favorite part of being a Care Coordinator?

• My favorite part of my job is educating HealthFlex participants on their plans and how medical insurance works. I think the education piece makes it a bit easier for participants to know what to expect when claims process. I also enjoy contacting providers’ offices to help “unstick” participants from being in the middle of insurance and provider issues.

Can you tell us a bit about your Care Coordination team or “pod,” and how you work together?

• We have a team of Care Coordinators and Clinical Care Coordinators. We also have multiple Claims Specialists, Chat Care Coordinators and Managers. We work together to get information from participants and providers and share with our clinical team for review. We get claims reviewed and sent for reconsideration with the claims team. We help connect participants dealing with unforeseen health diagnoses with our Personal Care Guide nurses. Every person on the team plays a part, and we depend on each other to fill in pieces of the puzzle.

What are some of the most common questions you get?

• What is a deductible? What is co-insurance? What is an out-of-pocket max? Can you see the money I paid to my doctor? Is a certain doctor/facility in my network? What happens if I go to an out-of-network provider? Why am I receiving this bill? Can you help me with a question about my prescription?

What are some ways you can help participants that they might not be aware of?

• We are able to call out to billing offices—if you overpaid at your doctor’s office, we can call the office to help initiate a refund. We can help request your provider place a hold on your account if a claim is reprocessing. We are able to call doctors to request information for prior authorizations. We can assist in breaking down details on a bill you receive from your doctor. We can walk you through all the benefits offered by your plan and help simplify some of the more complex situations. We are able to connect you to a nurse for support for challenging diagnoses. 

What do you wish more participants knew about Care Coordinators?

• I would say if you are unsure about a bill you have received, give us a call. We can check your claim to make sure it was processed correctly. Sometimes we find claims have been denied or are asking for additional information and members are still being billed. As Wespath Care Coordinators, we can help with many things that traditional insurance companies will not or cannot.