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WellPath Health Insurance Company

The WellPath Health Insurance Company offers coverage to people living in North Carolina and South Carolina. Residents of these states can choose from a variety of health insurance options offered by WellPath.

WellPath is a subsidiary of Coventry Health Care, Inc., and serves the needs of more than 160,000 policyholders (click here to read the full Coventry Health Insurance review). Coventry Health Care is a large company providing benefits to subscribers in all parts of the United States. It covers more than 4.6 million plan members. Coventry Health has been included on lists of top performing companies by Fortune 500, Barron’s 500 and the Wall Street Journal.

Read this WellPath Health Insurance review, take a look at the customer reviews of WellPath Insurance at the bottom of this page, and then enter your zip code in to compare free quotes from many different health insurance providers.

WellPath Health Plans

One of the coverage options available to WellPath policyholders is a Health Maintenance Organization (HMO) model. An HMO has the advantage of being an economical choice for policyholders who want to get coverage at an affordable price. Plan members pay a set amount each month for their medical coverage, and this rate stays constant no matter how often they need care during the month.

People who are considering an HMO model for their medical care need to understand that in return for a fixed rate each month, they are giving up some choice over where they can get treatment. An HMO client must designate a doctor to be their primary care physician. Visits to a specialist require a referral from this doctor. Medical care must be provided by doctors and hospitals within the HMO’s network of providers to be covered under the plan.

A Preferred Provider Organization (PPO) is also a form of managed health care. The difference between it and an HMO is that a PPO has a group of doctors and hospitals in its circle of providers who agree to provide services to a specific group of people. The plan may be available to employees of a particular company or companies or an association. The healthcare providers agree to provide services to the pool of plan members at a reduced rate. The company or association agrees to offer incentives to members to sign up for the PPO and visit doctors and hospitals forming part of the network.

A PPO is different from an HMO; it’s not a prepaid health plan. People who sign up to be members pay for their medical care as they go. The plan reimburses them for the costs of services provided, less any copays required. The doctor may submit his or her invoice directly to the plan administrators for payment as well. The plan member is responsible for any copays required.

An advantage to choosing a PPO plan for healthcare is that plan members have more choices in which doctors and hospitals they seek treatment from. To get the maximum amount of covered care under the plan, they are asked to seek treatment from a participating doctor or hospital. Seeing a healthcare provider who is not a member of the PPO’s network of providers means that a level of coverage is offered.

Another option available to WellPath Health customers is a Point of Service (POS) plan. This option has characteristics in common with HMO’s and PPO’s. Like an HMO, there is no deductible. Plan members are required to designate one doctor as their primary care physician. Going outside of the network to seek treatment means that you will need to meet a deductible before the company will pay benefits. Copayments are also substantial for people who seek treatment from outside the plan’s network of providers. A referral is required before a plan member can consult a specialist.

WellPath Plans Offered to Medicare Recipients

WellPath offers the Advantra North Carolina PPO option to Medicare recipients. Plan members don’t need a referral to see the doctor of their choice. A copay may be required for certain services. Hospital stays are covered under the plan, with a copay required for the first 10 days of treatment. After that point, plan members are fully covered. Inpatient mental health care is also covered under this coverage option, subject to the same copay as in hospital treatment. Plan members are also covered for care provided by a skilled nursing facility, home care and hospice services.

Add-On Services Offered By WellPath Health

The WellPath Health Insurance Company also offers vision, dental and prescription coverage as an add-on to the plans it offers to consumers. Plan members who want prescription coverage can choose to receive their medications from one of a large network of chain pharmacies and independent drug stores. They can even use a mail order service for their convenience.

WellPath Health Insurance Quotes

You should certainly compare your WellPath health insurance quotes with quotes from other top companies to find the best plan. To find out more about the plan options offered by top insurance companies like the WellPath Health Insurance Company, click on the insurance quote tool at the top of this page. You will be able to find the right kind of coverage for your needs, quickly and conveniently. Why don’t you click on it right now to find out about your options and start comparing quotes from the best health insurance providers?

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13 reviews

  • Lance Graven /
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    Wellpath is horrible.

    Many providers in our area that used to be on Coventry are no longer on Wellpath. I have to plan a day trip just to see the nearest providers.

  • SciPirate /
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    WellPath Coventry is awful.

    They’ve failed to keep up with my basic information like my birth date and address. I’ve had to battle with my doctor’s offices and WellPath to make sure procedures are covered. Recently I’ve switched insurance companies and have canceled WellPath’s policy, and they’re still drafting my account.

    Apparently, faxing my form to discontinue service several times to 3 different fax numbers, emailing their customer service representatives, speaking with several employees over the phone, and physically mailing my form in was not good enough. I’m going to have to take off work and travel to one of their offices and speak with these people in person to get anything done and get my money back. They’re requesting that I show them that I’m now covered under another insurance company in order to get my money back that they drafted from my account.

    I’m furious with these people. I do not recommend this insurance in the least.

  • cierrabear /
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    They are deceitful about what they will actually cover, and customer service reps. always met my concerns with sarcasm.

    Don’t trust any information from their online services……I wish I could leave zero stars…

    • 11111
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    This is the worst health insurance company I have ever dealt with.

    Not only do they refuse to pay claims for services they are supposed to provide, they also have major issues with doctors in our area accepting their insurance. I’ve recently signed up with another REPUTABLE company for better coverage, lower premiums and deductible, and every doctor in the area gladly accepts it because there is no hassle and they get paid timely.

    Along with cierrabear, if I could leave the stars blank or put a – in front of it I would.

    My recommendation: If you have them, dump them. If you don’t have them don’t even think about switching to them.

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    Our company just change from BlueCross to Wellpath in an effort to keep costs under control. My experience with Wellpath is very limited but if their customer service is any indication of what is to come we made a big mistake. Only time will tell and I hope I am wrong but I do not think I am.

    Currently, I would not recommend them to anyone.

    • 11111
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    Richland county SC changed from BCBS to wellpath 10-01-11 My 1st dealings was,let’s say it sucked! For a generic drug copay that was $10.00 from BCBS is now $55.00. The service I received over the phone was bland and cold The take it or leave it type.

    I sure hope RCHR works out the bugs to this insurance company.As for as RCHR thanks for the advanced notice for the change. To submit this review I had to give and rating.I gave 1 star for each rating .1 star to many

  • Sabra Robinson /
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    I am so sick of Wellpath.

    My company switched from BCBS (with great service) to WellPath and it’s BEEN HORRIBLE!! My husband has Lupus PLUS NonHodgkins Lymphoma Large B Cell and received excellent service at the ER last year in Charlotte, NC. Once that switch was made, it appears that service dwindled and I’m just now realizing as I type this that maybe my poor service was because of this terrible insurance company. I’ve heard of several doctor’s offices dropping them.

    My husband needed about 3 MRIs and for each one it HAD TO BE APPROVED!!! Even our last doctor visit, the doctor issued a STAT MRI, but no, WELLPATH requires review and approval.

    I just got off the phone with them and the customer service rep said, ‘yes, we received it yesterday and yes it’s marked urgent, however the director has to review and approve it first’. What?? My husband is lying in bed with severe pain and I can’t even take him to the ER again because they denied my last claim when I took him to the ER and have to file an appeal. REALLY? I was so angry I told the lady they stunk and I will be posting on FB how terrible their service is and I hung up.

    I WOULD NEVER RECOMMEND ANYONE TO GO WITH WELLPATH. BEWARE!!!! THEY ARE SLOW TO PAY AND THEIR DELAY CAN COST YOU YOUR LIFE!!!!

  • Bill Willis /
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    I too was switched from BCBS to WellPath with little to no heads-up. Thanks, Richland County SC Human Resources Dept. for honoring my thirty years of dedicated service, with a health insurance policy plan that barely meets my family needs.

    While looking for better health coverage, I was told that the Coventry Wellpath Health Insurance plan contracted with Richland County “was not labeled as health insurance coverage” so to speak. In dealing with Wellpath lately, I agree! It is little to no or “minimal at best” coverage.

    I understand RCHR needing to save money, but for what you are paying, is Wellpath the best health insurance plan you could find for the money for your dedicated employees?

    Saving money is important, but I never understood why government always starts at the bottom, instead of at the top. Oh yes, now I understand! What happened to all the funds that were in the “pot” to begin with? (Would not let me rate less than one star)

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    Wellpath is the worst health care plan I have had!! A zero rating would be checked if listed! I have had earlier issues with Wellpath, but recently I was in an emergency situation, and the doctor’s office could not reach Wellpath on the phone, other than an answering machine, to get pre-approval on services needed. And guess what, no one has returned a call as of yet!! And in the past, an answering machine is the norm!

    In talking with several of my doctors’ offices as well, Wellpath is not paying in a timely manner, and when they do, they pay what they want. Several of my doctors’ offices are frustrated with Wellpath and now talking about refusing to accept Wellpath as an insurance provider for their practice.

    I am now looking around for other coverages and interestingly enough, they tell me that they don’t consider Wellpath as a “Health care plan”. I sincerely hope that RCHR SC will work on these problems with Wellpath, and not let those down that work for them, along with those like me, that gave 30 them years.

    I understand the reasons for cutting cost and greater health for employees not routinely seeing doctors to maintain good health. But much larger co-pays along with much greater deductibles on tests needed/performed doesn’t seem to me to encourage employees to maintain their health as planned, especially those with health issues already!

    Although the premiums were reduced (not by much by the way), is Wellpath the best you could find for the money? I don’t think so!

  • Richard Jackson /
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    My company changed from BCBS in October of 2011. I went to my PCP for something BCBS covered with no questions asked. WellPath charged it against my deductible. I have never gotten an EOB from them. Cannot get to first base with them.

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    HORRIBLE COMPANY!

    I have spent HOURS on the phone with them trying to get things straightened out. I added it up and we could have put aside the money we were paying them and actually paid for the stuff that they are denying.

    They will find ANY reason to deny a claim. Getting rid of them after this month! DO NOT use this insurance company.

  • Allison Riley /
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    Denied ER visit in April. Husband injured back and was unable to walk, sit, perform basic self care. Pain score of 10/10. Concerned that he had severely injured spine we went to ER. Later tests showed that he did have an injury to a disc.

    Well, path/Coventry denied the ER visit because they say it didn’t meet their definition of Emergent.

    I filed an appeal which was also denied. Guess I will need to appeal that for all the good it will do. Will be letting my employer know and also looking for different insurance.

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    I guess pretty cynical reviews here . I’ve had no problems with my insurance.

    My daughter had a serious issue with having to see several specialists in the Charlotte area and everything was covered like it should be. Everyone accepted the insurance that we had to see.

    We never had to call customer service so I can’t comment on that- who likes calling 800 numbers anyway

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