Is it covered?
"Can I use my WEX card for prescriptions?"
No
Where is the WEX job aid located?
Previously purchased item denied, why?
Each merchant and merchant location has their own list of approved OTC items that can vary from location to location. The list is subject to change at any time, from approved to no longer approved. This does not happen frequently, but it can happen.
For members requesting a list of OTC items, we should...
Direct the member to the member portal to see a general list. Educate members can order by phone, or online through the OTC store where items are always approved. Advise members can speak to an approved merchant employee to see what is considered OTC approved for the plan.
In addition to OTC items, what else can the WEX card be used for?
Some plans may offer non-Medicare covered Dental, Vision, and Hearing costs. Our DSNP plan offers healthy groceries. Check the member's benefits for details.
Who determines what items are covered OTC?
Merchant. Each merchant and merchant location has their own list of approved OTC items that can vary from location to location.
Where do we go to locate the member's card balance?
We should visit the WEX Health Cloud Administration Portal: https://essencehealthcareadmin.lh1ondemand.com/Login.aspx?ReturnUrl=%2fMain.aspx
Once in the site click on: Accounts > Account Activity.
"I ordered a replacement card. When will it arrive?"
Allow up to 14 days. Expedited requests may arrive within 5 days.
For members calling about Wex card being declined at the checkout counter, we should...
Ask the member what they attempted to purchase. Review the WEX portal to find out why the transaction denied, confirm the merchant is participating, and review the member’s current Wex balance to see if the member was spending more than the balance on the card.
What to do when the diabetic credit isn't showing?
1. Identify if the member is enrolled in a plan that has the extra OTC benefit. If no, explain the benefit and listen for grievances. If yes, proceed.
2. Ask the member if they have diabetes. If no, explain the benefit and listen for grievances. If yes, proceed.
3. Identify if the member is indicated as “Diabetic” under the Diabetic Status.
4. If no, route the call to CHANGE DIABETIC STATUS. Document that the member has diabetes and request the extra benefit be added. The extra benefit should be available through the vendor as soon as enrollment updates the chronic care value in Facets and a new eligibility file is sent to the vendor. Let the member know that the benefit should be available within one week and that the member can call back if they have additional issues.
"I bought an item without my WEX card. Can I be reimbursed?"
When using the card in person, the member must use the card at the point of sale. The member cannot buy an item out-of-pocket and get reimbursed.
Name the three ways to purchase OTC items. What information can we give to our members to help achieve first call resolution?
Members can order online by visiting EssenceHealthcareOTC.com (approved list of items available)
Members can order by phone at 877-494-2806. (approved list of items available)
At approved stand-alone merchant locations. Members can use the merchant locator on the WEX portal.
"My OTC card was stolen and purchases were made. Can I file a dispute?"
Yes, the member has the right to dispute the transaction within a timely manner. The member must complete a Transaction Dispute Form to make this dispute. This form must be completed and mailed directly to WEX who will handle the review of the form. If the card is lost/stolen or the member believes there is fraud, we should issue a new card.
For members calling about a product purchased with their Wex card being defective, we should...
Direct the member to speak to the merchant where the product was purchased to either get a refund or have the product replaced.
Name one of the top three reasons why members call in regarding their Flex card.