Wellcare Fax Numbers

Wellcare splits by what you are asking for

Most insurers route by state. Wellcare routes primarily by request type, and each type has its own department and its own fax line.

A grievance is a complaint about the plan itself: a wait time, a privacy concern, how you were treated by customer service, information you were not given. That goes to the Grievance Department at (866) 388-1769, within 60 days of the problem.

A coverage determination, also called an exception, is a request to cover a drug that is not on the formulary, to waive a prior approval, or to move a drug to a lower cost tier. That goes to (866) 388-1767 for Medicare Advantage plans outside California and for Prescription Drug Plans, and to (877) 277-1809 for California Medicare Advantage plans.

An appeal, which Wellcare calls a redetermination, is what you file after a coverage request is denied. That goes to Medicare Pharmacy Appeals at (866) 388-1766, within 65 days of the denial letter.

What Wellcare members send

The documents that move by fax are the ones with a deadline attached:

• A Request for Redetermination of Prescription Drug Denial, with the denial letter it responds to
• A drug coverage determination request, which has to include your prescriber’s statement explaining why the drug is necessary for your condition
• A grievance describing what happened and when
• An appointment of representative form, letting a spouse, caregiver, or your prescriber act for you
• Supporting clinical records your prescriber has provided

Wellcare states it decides a standard coverage determination within 72 hours of receiving the prescriber’s statement. Missing that statement is the most common reason a request stalls, so send it in the same transmission rather than separately.

Verify the number before you send

Appeal packets carry your name, member ID, diagnosis, and prescriber notes. Confirm the destination first:

• Use the fax number on the denial letter in front of you when there is one. Wellcare says to look there, and a plan-specific number beats any general one.
• Match the number to the request type. A redetermination faxed to the grievance line is not an appeal, and the clock keeps running.
• California Medicare Advantage plans use a different coverage determination line from every other Wellcare plan.
• Wellcare plans change at the plan year, and so can these numbers. Check the current year’s page or your Evidence of Coverage rather than an old letter.

How to fax Wellcare without a fax machine

Create a free FaxTerra account with an email address, upload your form and any supporting records as a PDF or as photos taken with your phone, enter the Wellcare fax number for your request type, and send. Delivery confirmation arrives by email with a timestamp, which matters when an appeal window is measured in days.

A short form sends free within your monthly free pages, and a full appeal packet with clinical records is covered by a one-time credit pack from about 10¢ a page. See how to send a fax for accepted files and page limits, the Humana guide if you also have a Medicare Advantage plan elsewhere, faxing an insurance claim for the appeals process generally, and faxing medical records when the plan asks for clinical records to support the request.