Employees

1. Who is WEHP?

WEHP is WellMed Employee Health Plan which offers self-directed health plans to WellMed employees and their families. There is a select group of staff members who have signed confidentiality agreements, have secured offices, exclusively process the WEHP referrals then transfer data to BMA for claims payment processing.

2. Who is BMA?

Benefits Management Administrators (BMA) is the third party administrator who processes the enrollment forms and pays claims for the WellMed employees and their families who sign up for our health plan options. We have a third party administrator for confidentiality purposes to help ensure the protection of your patient health information.

3. Are WEHP physicians board certified?

The majority of our physicians are board certified. We also have our own credentialing department who verifies and tracks the credentials and licensures of all of our physicians and physician assistants.

4. What is a PA?

A PA is a Physician Assistant who can provide healthcare services under the supervision of a physician.

5. What type of qualifications does a PA have?

They must have graduated from an accredited college or university and have an advanced degree as a Physician Assistant.

6. What types of services are PAs qualified to perform?

  • Take your medical history,
  • Conduct examinations,
  • Order and interpret lab and x-rays,
  • Make diagnosis,
  • Prescribe medications,
  • Remove skin tags or moles and
  • Treat minor injuries by splinting, suturing and casting.

7. Do the PCPs and PAs know what the health plan expects of them?

Yes, all new and existing PCPs and PAs are educated about the health plan and their roles.

8. How do I find out if my specialist is contracted with WEHP?

As a patient of WellMed, you should speak with your primary care physician directly regarding the contracted specialists with his/her medical group as the list of specialists may vary by medical group.

9. Why do I need a referral from my PCP to see a Specialist?

The EPO ("Exclusive Provider Organization") plan is set up to allow the PCP to direct the care of all members who sign up with them. If the PCP feels he/she cannot provide the care needed to the patient, approval of a Specialist visit is part of their responsibility in caring for the patient.

10. What is the turnaround time for referrals?

Referrals are only applicable for the EPO plan. Once the referral is received from the PCP, it is usually turned around on the same day. Some referrals require us to get records and discuss in UMC (“Utilization Management Committee”). It can take up to 8 days before medical records are received and taken to UMC. For more details, see the Referral process section under the EPO plan.

11. Can I get 3-4 visits to the specialist if I know I am going to need to continue to see them?

You will need to discuss that with your PCP since he/she is the one responsible for authorizing any care needed outside of what he/she can provide. Some referrals may have multiple visits but the referral is only good for a 60-day period.

12. Do I need a PCP referral for Mental Health?

No, you may self refer (go on your own) to Alamo Mental Health as this benefit does NOT require a referral from your Primary Care Physician. WellMed Employee Health Plan’s Behavioral Health Benefit is provided and managed by Alamo Mental Health. Their phone number is (210) 614-8400.

13. Where do I go to get a mammogram, CT or MRI?

Our preferred provider for mammograms, CTs, and MRIs is Bexar Imaging Centers. There are two locations one is located across from North Star Mall and other is off 7622 Louis Pasteur across from the Methodist Children's Emergency Room.

14. How do I file a complaint?

Member Satisfaction is very important to us. If you or your family are not satisfied with the services you receive during your visit, we encourage you to contact BMA directly or the WEHP staff noted on the WEHP Quick Reference Contact Listing in the Contact Us section of this website. There is also a WEHP Concern Form in the Forms Section which you may complete then either fax or mail to us regarding your concern so we may assist in resolving any issues you may have. Such concerns will be tracked in order for us to identify areas of improvement.

15. What is considered to be an Emergency and what should I do in that situation?

  • EMERGENCY – A medical condition manifesting itself by acute symptoms or sufficient severity (including severe pain) such that a prudent layperson, with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
  • Serious jeopardy to the health of the individual or, in the case of a pregnant woman, the health of the woman or the unborn child;
  • Serious impairment to the bodily functions; or
  • Serious dysfunction of any bodily organ or part.
  • When you have an emergency please remember your Primary Care Physician’s office has a doctor on call 24 hours per day 7 days a week. If time permits, call for direction. Otherwise, notify your PCP the next business day after your emergency.
  • Examples of an Emergency include chest pain, uncontrolled bleeding, loss of consciousness, or a life-threatening illness.

16. What is considered to be Urgent Care and what do I do in that situation?

  • URGENT CARE – These are covered services provided when you are temporarily out of the service area or, under unusual and extraordinary circumstances, provided when you are in the Service Area but your Primary Care Physician is temporarily unavailable or inaccessible when such services are medically necessary and immediately required;
  • As a result of an unforeseen illness, injury or condition; and
  • It is not reasonable given the circumstances to obtain the services through your Medical Group.
  • A temporary absence is an absence from the Service area lasting not more than six (6) months and is not a permanent move.
  • If you have an Urgent Care need during regular office hours, call your PCP first for direction as all of our medical groups hold appointment slots for urgent care situations so you may be seen that same day. After hours, you may be referred to the Texas Med Clinic which has a lower copay than the hospital emergency room copay.
  • Examples of Urgent Care Needs include injuries without suspected fracture, persistent vomiting or persistent fever greater than 102.

17. What do I do if I have an emergency after hours when my medical group is closed?

All WEHP contracted medical groups have a provider on-call after office hours, 24 hours a day, 7 days a week. The answering service will notify the provider on-call of your urgent or emergency need. The on-call provider will then call you back and provide appropriate directions for your health care needs.

18. How does WellMed protect my patient health information?

With the new Patient Privacy Act effective April 14, 2003, WellMed has implemented various policies and procedures as well as staff and provider training regarding the protection of patient health information. When patients or someone on their behalf calls into the medical group inquiring about a patient's health information or to verify an appointment, he/she (even if person is the patient) will be asked to answer three questions regarding the patient's personal information to assist in the protection of the information. Our patient consent form also has an area on the form so patients can provide us permission to release their information to certain persons.

19. How to I participate in a clinical research program?

You may simply click on www.wellmedclinicalresearch.net which will inform you of the current studies and who you may contact regarding enrollment.

Should you have any questions BMA Customer Service staff (210) 697-9900 or (800) 934-6302. WEHP Customer Service will also be happy to assist you at (210) 617-4011.