Frequently Asked Questions
One of the great benefits of Apple Health is that there is no deductible or medical/prescription copays. Most visits are covered at 100%. You can see a list of benefits available to you under Member Benefit Information. If you should receive a bill or have the pharmacy tell you that a certain prescription is not covered, please give Member Services a call at 1-877-644-4613 so that they can help resolve the issue.
Rewards are typically processed 2-3 weeks after completing an activity. If after this time you still don’t receive your rewards it could be that we have not received the claim for this visit, which is what tells the system to reward you. Another reason could be that you went in for a physical, but also talked about a health concern, which can cause the doctor to bill the visit as a problem visit instead of a normal physical. Please contact Member Services at 1-877-644-4613 to assist you if you experience any issues.
Dental is not covered through Coordinated Care but it is a covered benefit through ProviderOne, which is a different card than your Coordinated Care Member ID Card. You would use the ProviderOne Member Services card when you go to the dentist.
You can find out what is covered by calling the number on the back of the ProviderOne card or under Member Benefits.
We encourage you to see a doctor in our network, but you may choose to see an out-of-network provider. It will be up to that provider if they want to accept your insurance or not. Office visits and/or consultations from non-participating providers no longer need a prior authorization, but any procedure needed during the visit may need an authorization. It will be up to you and the provider to make sure to check and see if any authorizations will be needed during the time of your visit.
Physical Therapy is a covered benefit under Apple Health. Prior Authorizations are required for non-par providers only. There are no limitations on visits. Visits are covered based on medical necessity.
There are a few reasons why you may receive a bill. It could be that the doctor did not send us a claim, which is causing them to send you the bill. Another reason could be that they don’t have the correct insurance information, or it could be that they sent you the bill by mistake. Please contact Member Services at 1-877-644-4613 to help resolve the issue.
Yes there is a way for you to get your refill early. You are allowed 1 vacation override a year, which allows us to give you an early month’s prescription.
There are 2 ways to look for a PCP. You can search our Find a Provider database. There you can choose to look for many different types of providers near you. Once you choose a doctor, you can log into your Member Account and change your PCP. The other option you have is calling Member Services at 1-877-644-4613 to assist you with looking for a PCP and then assigning that doctor to your account.
- Vision is a covered benefit under Coordinated Care. For adults 21 and over, the exam is covered every 2 years. Children 20 and under, the exam is covered every year.
- Glasses are covered for children 20 and under. You will need to contact a vision provider that accepts ProviderOne. Glasses are not covered for adults 21 and over. For more information about glasses, please contact the Washington Health Care Authority at 800-562-3022.
- If you applied through the Washington Healthplanfinder, please contact the Washington Health Care Authority’s Medical Eligibility Determination Section (MEDS) at 1-855-623-9357 or you can also send a request to Medical Eligibility Determination Services (MEDS) online. Make sure to provide your name, date of birth, and client ID number/ Medicaid ID.
- If you applied through the DSHS Community Service Office, please contact 1-877-501-2233 or the Washington Connections website.
The Erin Act, allows a baby to be covered for the first 3 weeks (21 days) under their mother’s insurance. After the 3 week time span the child will need to be enrolled on their own insurance through Washington Health Plan Finder. For further information on your baby’s coverage please refer to the Erin Act or call the Washington Health Plan Finder at 1-855-923-4633.
*Note: Please refer to section 3(f) under the Erin Act: RCW.48.43.115