FAQs for Providers

1. How do I apply on behalf of my patients?
2. Do you cover the entire copayment or just certain treatments?
3. How do I get reimbursed? What do I submit? Will I receive a check?
4. My patient received a plastic HealthWell pharmacy card with his or her enrollment letter. How is it used?
5. Are approvals retroactive?
6. How do I check the status of my grant?
7. How do I check the status of my payment?
8. How long do I have to submit a claim for reimbursement?

Important Documents

Statement of Treatment 
Terms and Conditions 
Reimbursement Request Form
Understanding Payment Denials
Tips for Working Efficiently with HealthWell

How do I apply on behalf of my patients?

The easiest and fastest way to apply is to complete the application online. If you do not have access to a computer, you can call to apply (800) 675-8416. 

If pre-approved, submit the following required documentation within 30 days:

• Complete Statement of Treatment with the prescribing provider’s signature
• A copy of the patients insurance and pharmacy card(s) – front and back.
• If requesting premium assistance, also include:
  • Documentation from your insurer or employer confirming the portion of the health insurance premium you are responsible for paying 
  • Documentation that your insurance will cover the medications for the disease state.  You may submit any of the following:
    • Letter from insurer, or
    • Explanation of Benefits (EOB) form (must include patient name, insurer name, drug name and copay amount), or
    • Recent pharmacy receipt (must include patient name, insurer name, drug name and copay amount)

We must receive ALL the required documentation within 30 days of approval or the grant will close.  You may start the pre-approval progress again, however the approval date will reset.  

We will not call or send letters requesting any missing required documentation.  It is the responsibility of the patient and provider to ensure we received the required documentation within 30 days of the pre-approval.

For fastest service, please fax these items to us at (800) 282-7692.

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Do you cover the entire copayment or just certain treatments?

The Foundation pays only copayments related to prescription treatments taken specifically for the medical condition listed in the application. The Foundation typically does not reimburse for lower cost treatments, such as steroids, pain medication, and generic medicines. Please keep in mind that patients are free to change the type of medication they are taking or their provider at any time without affecting their eligibility.

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How do I get reimbursed? What do I submit? Will I receive a check?

Upon receipt of the required documentation, the patient will receive a Reimbursement Request Form in the mail with the approval letter. The patient must submit a Reimbursement Request Form, along with an invoice and proof of payment, each time he or she has an out-of-pocket cost for an eligible medication. If the patient has not yet paid the copayment or premium, the patient should indicate this on the Reimbursement Request Form, and we will mail the payment directly to the pharmacy, physician, or insurer. If the patient has already paid the premium or copayment, the Foundation will send the reimbursement check to him or her. Please note that the patient must include proof of payment with all reimbursement requests. Proof of payment includes a copy of a canceled check, a credit card receipt or statement, or an itemized receipt from the pharmacy or doctor listing the drug purchased. Many times we are able to coordinate billing with the pharmacy or physician. In these cases, we will send the award payment directly to them after the patient has received his or her medication. Please contact us to discuss a direct billing arrangement.

Depending on the disease fund a patient is enrolled in, he or she may also receive a HealthWell Pharmacy card with the enrollment letter. If so, please see the next question.

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My patient received a plastic HealthWell pharmacy card with his or her enrollment letter. How is it used?

The patient should bring the HealthWell pharmacy card to the pharmacy when filling his or her prescription, or call the mail order pharmacy and provide the numbers on the card. The card is similar to an insurance card and the pharmacist should be able to use it to pay the copayment for the treatment. If the pharmacist has questions about how to use the HealthWell pharmacy card, he or she may call the pharmacist telephone number on the front of the card.

The patient cannot use the pharmacy card for treatments received at a doctor’s office. Instead, the physician must fill out a Reimbursement Request Form, which was received with the patient’s enrollment letter, and fax it to HealthWell with an invoice that shows the cost of the treatment.

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Are approvals retroactive?

If approved, the patient grant is held the day of the call or online pre-approval. Eligible Dates of Service (DOS) for reimbursement start the day of the call or online approval.

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How do I check the status of a grant or payment?

You can check the status of a grant or payment anytime by using our secure online provider portal.  To get started, please return to the homepage and click on the blue button called MY PATIENTS-MY PORTAL.  You can also use our automated telephone menu system by calling (800) 675-8416.

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How long do I have to submit a claim for reimbursement?

HealthWell will reimburse for dates of service beginning the date of approval and after, however:

• Payable claims must be received at HealthWell no more than 120 days after the date of service.
• Claims received after April 30 for the previous enrollment year will not be paid.
• To remain eligible for assistance, HealthWell must receive a reimbursement request within 90 days of the enrollment start date and continue to receive requests at least every 90 days or the grant will close.  You may continue sending in reimbursement requests, however payment will depend upon available funding.  

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Other questions?  Please contact us.