Your prescriber may ask us for a coverage determination on your behalf. If you want another individual (such as a family member or friend) to make a request for you, that individual must be your representative. Contact Us to learn how to name a representative.
| Address | Fax Number |
| Wellcare Health Plans |
You may also ask us for a coverage determination by phone at 1-888-550-5252.
If you or your prescriber believe that waiting 72 hours for a standard decision could seriously harm your life, health, or ability to regain maximum function, you can ask for an expedited (fast) decision. If your prescriber indicates that waiting 72 hours could seriously harm your health, we will automatically give you a decision within 24 hours. If you do not obtain your prescriber's support for an expedited request, we will decide if your case requires a fast decision. You cannot request an expedited coverage determination if you are asking us to pay you back for a drug you already received.
CHECK THIS BOX IF YOU BELIEVE YOU NEED A DECISION WITHIN 24 HOURS.
If you have a supporting statement from your prescriber, attach it to this request.