How to Get Reimbursed
- Once a patient is approved, we begin reimbursing for dates of service and prescription fill dates that fall within the enrollment period.
- Patients will receive a HealthWell Pharmacy Card and a Reimbursement Request Form.
- If the pharmacy can use the HealthWell Pharmacy Card for a prescription fill, there is no need to submit a Reimbursement Request Form.
- You may need to verify the patient’s diagnosis in order to continue receiving payments after the first one is made. You’ll find Diagnosis Verification Forms here.
Using Your HealthWell Pharmacy Card
- Before submitting your HealthWell Pharmacy Card for payment, make sure the pharmacist runs all applicable INSURANCE and PRESCRIPTION cards, and any applicable MANUFACTURER coupon or discount cards first.
- To use the card, simply provide the billing information on the pharmacy card at any specialty, retail or mail order pharmacy.
- You must use the HealthWell Pharmacy Card regularly to keep your grant active. Please make sure to use your card at least once every four months.
- If you can’t find your card, you can look up your card number here.
Using Reimbursement Request Forms
- Use a reimbursement form in cases where you cannot use your pharmacy card. Forms are available here.
- For copayment assistance, we encourage you to please use your HealthWell pharmacy card for any applicable charges as possible.
- For premium assistance, HealthWell prefers to pay your insurer directly, and we can only reimburse on one insurance policy’s premium at a time. We encourage you to please submit monthly reimbursement claims (even if your premium is paid on a bi-weekly basis).
Copay Reimbursement Request Forms
- Download reimbursement forms for your insurance copays here.
- Upload completed Reimbursement Request Forms through your respective portal — PATIENT, PROVIDER or PHARMACY. You may also fax them to (800) 282-7692.
- All reimbursement requests must include the following:
- Completed and signed Reimbursement Request Form
- All required documents outlined on the form
Premium Reimbursement Request Forms
- Download reimbursement forms for your insurance premiums here.
- Upload completed premium reimbursement request forms through your respective portal — PATIENT, PROVIDER or PHARMACY. You may also fax to (800) 282-7692.
- The first premium reimbursement request submitted must include:
- Completed and signed Premium Reimbursement Request Form
- All required documents outlined on your approval letter
Important Guidelines, Practices and Forms
- Always run each claim through all other insurance, prescription cards and manufacturer programs before using your HealthWell Pharmacy card.
- We request that grants are used at least every 120 days either through the pharmacy card or through timely submission of reimbursement requests.
- Once we receive a complete payable reimbursement request, you should receive a reimbursement check in approximately two weeks.
- A patient may change assistance type — that is, switch from copay to premium assistance or premium to copay assistance — one time during his/her enrollment period.
- As an added note, some patients who have been approved for a grant are required to submit income documents for review. During the review process, the patient’s grant will be temporarily inactive until his/her income has been verified. Download the required Income Verification Statement below.
- Additional forms and guidelines:
- Cancer-Related Behavioral Health Statement
- Travel Fund Reimbursement Form
- COVID-19 Ancillary Costs Fund Reimbursement Request Form
- COVID-19 Frontline Health Care Workers Behavioral Health Statement