Subject: Health benefit fund report
Henry is one of our retiree health fund rep’s. The following is an article with good reminders and info.
I know I have written about the following subject many times, however, at the risk of subjecting you to a deep case of boredom I’m going to do it again.
In trying to give our members the best mail order pharmacy service, the Health Fund has been forced to change from one provider to another. We always know the change will cause some disorder for the first couple of months. I too have suffered some disruptions in receiving my mediations. Hopefully the following suggestions will help all of us weather this temporary muddle.
You should order you medications at least 21 days in advance so you don’t run out. If you have no more refills, you will need to ask your doctor to send in a new prescription. Some prescriptions will need Prior Authorization before WellDyneRx can send you the meds. Your doctor should contact WellDyneRx to request a Prior Authorization form. If your doctor has not called WellDyneRx to request the form, you can ask WellDyneRx to contact your doctor as a courtesy to start the Prior Authorization procedure
After your doctor calls WellDyneRx to request a Prior Authorization form, give it a couple of days to see if your order is being processed. If your order is not being processed, stop and take a deep breath. Your next move is to call the staff at the Health Fund office.
I continue to get three to four calls every week the most common problems:
1. My doctor says I don’t have an account: “You’re using the 2016 I.D. card.”
2. I called Envision and they told me I have no account with them. “Our provider is
3. The Health Fund is not paying my doctor. “You have not signed and returned you
2017 claim form.”
4. I called WEB/TPA and they told me my procedure is not covered. “You didn’t
If you have a problem with any of your benefits, don’t try to solve the problem by yourself. Call the Health Fund staff. Don’t call the doctor; don’t call Envision; don’t all WEB/TPA; don’t call Well/Dyne.
Who do I call????? Call the staff at the Health Fund office. The telephone number is on your white I.D. card.
The Health Fund Trustees and the Health Fund Staff are trying to do the best for our members. Decisions made by the Trustees are made after careful consideration of how it will impact our members. The Fund staff is very well informed and knowledgeable in health benefits. They are always eager to help solve or answer any questions posed by our members.
I visit the Health Fund office almost every day. I see the staff on the phone all the time. They spend most of their time helping our members pre-certify, coordinate with providers, solve problems with mail order prescriptions and answer any other questions that the members may have.
Unfortunately, however, they receive little thanks and a lot of scolding from some of our frustrated members. We understand the frustration that many members experience when their medication doesn’t arrive on time or some surgical procedure is not allowed; however, it is not the fault of the Fund staff. A snag in medication delivery happens to all of us at some time or another. The Trustees by the same token are not personally responsible if a procedure is not allowed. Benefits were set and accepted by the police and fire unions long before the Health Fund Board was formed.
The staff is always ready to work through the problems that our members encounter. Trustees on the other hand are constantly working to enhance and streamline the benefits and make it easier for our members to receive the necessary medications and surgical procedures. We can work through all our problems; however, all we ask from our members is to allow us a little patience.
This is information I just received and which I think is important to our members. We all know the importance of having a Prostate or Pap smear exam at least once a year. When you make an appointment at the clinic for a physical examination, be sure to indicate that you want a Prostate or a Pap smear exam. to be Included. Another item that is available at the clinic is an electrocardiogram, (EKG). You should include this exam in your yearly physical. It just takes a few minutes to take this important exam and those few minutes may be the ones that save your life. .