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GuideWell, formally GuideWell Mutual Holding Corporation (holding company for Florida Blue), is a mutual insurance holding company primarily focused on health insurance in Florida. It was created in 2013 by a reorganization initiated by Florida Blue, a member company of the Blue Cross Blue Shield Association . [ 4 ]
In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance.
WellCare began operations in 1985 in Tampa, Florida as a Medicaid provider for the State of Florida. [5] In 1992, Kiran Patel, a cardiologist and entrepreneur, purchased the company. [6] [7] In 2002, Patel sold it to a New York investment group led by George Soros and Todd Farha. [7] Also in 2002, Todd Farha joined the company as CEO. [8] [9]
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Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4] The payor returns the claim back to the medical biller and the biller evaluates how much of the bill the patient owes, after insurance is taken out.
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