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WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. WellCare began operations in 1985 and has its headquarters in Tampa, Florida.
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
In the US a certificate of medical necessity is a document required by Centers for Medicare and Medicaid Services to substantiate in detail the medical necessity of an item of durable medical equipment or a service to a Medicare beneficiary. [1]
Wellcare by Allwell Medicare Advantage (Part C) plans are sold by private insurers in 32 states in 2025. However, not every county or ZIP code in those states has access to every plan.
Durable medical equipment (DME) is a category of medical devices designed to assist individuals with disabilities, injuries, or chronic health conditions. [1] These devices are prescribed by healthcare professionals and intended for repeated use over an extended period.
The DME scheme was reminiscent of Medicare fraud in South Florida in the 1990s before it spread to other areas of medicine, such as physical therapy, diabetic injections and mental health services.
The logo of Anthem Blue Cross Blue Shield. Elevance Health, Inc. is an American for-profit health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. [2]
Amerigroup is an American health insurance and managed health care provider. Amerigroup covers 7.7 million seniors, people with disabilities, low-income families and other state and federally sponsored beneficiaries, and federal employees in 26 states, making it the nation's largest provider of health care for public programs. [1]