WGAT FAQs
Western Growers Assurance Trust (“WGAT”) is responding to the challenges posed by the Coronavirus (COVID-19) crisis. We know you have many questions about how your health benefits and your businesses will be affected by this crisis. Please see these FAQs below to find out what WGAT is doing to improve your access to care and how you can reach us if you have questions or concerns.
Is it business as usual for WGAT?
Like many of you, WGAT has transitioned most of its employees to work-from-home. Thanks to significant investments in technology over the years, our conversion was seamless. Please be reassured that our teams and departments are up and running and ready to answer your questions and address your concerns.
Does WGAT cover testing for COVID-19?
Yes. WGAT will cover medically necessary testing and screening with no cost-sharing (copay, deductible and coinsurance are waived). The same goes for the office visit where the purpose of the visit is to be screened and/or tested for COVID-19. Office visits include telehealth, hospital, emergency department, urgent care and provider office visits.
Are there any prior authorizations required for COVID-19 treatment?
WGAT will not require prior authorization for medically necessary COVID-19 testing or screening, including a related hospital, office, telehealth, emergency room, or urgent care visit.
How much do tests and test kits cost?
WGAT is waiving all cost-sharing and any prior approval for COVID-19 testing prescribed by a physician. The average test cost is estimated to be $60.
Is WGAT’s COVID-19 claims activity being tracked?
Yes, WGAT is tracking this activity.
When will WGAT be ready to process claims with no cost-sharing for any COVID-19 related services?
Claims received after March 5th related to COVID-19 services will be re-adjudicated at zero cost sharing as mandated.
Will grievances and appeals from providers and participants be addressed if either party believes the claims were not processed correctly?
Yes. WGAT is prepared to address grievances and appeals for providers and participants based on the mandate.
How will a participant be reimbursed for office visits or telehealth services related to COVID-19 if they are asked for payment at time of service?
The participant should call the number on their medical card and Customer Service will work with them to issue a reimbursement. We are encouraging our participants to make use of Doctor on Demand. WGAT is waiving all copays regardless of diagnosis for doctor visits exclusively through our partner Doctor on Demand. This, of course, includes telehealth visits for COVID-19 screening.
WGAT is also expanding telehealth services by making all telemedicine programs “in network.” If the claim pertains to COVID-19 screening, copays and deductibles are waived; if it is any other type of claim, they are subject to copays and deductibles.
When a vaccine is finally made available, will that be covered?
Yes, it will be covered.
What if a participant cannot access their current supply of medication or requires an early refill of their medication?
WGAT will be suspending prescription fill/refill limitations and refill waiting periods to allow enrollees to order a 90-day supply.
Has WGAT received any claims related to COVID-19?
WGAT will not comment on whether any of its plan participants have the virus or are receiving treatment due to federal privacy laws.
Can I practice social distancing and conveniently access prescription medications?
Members can practice social distancing in several ways:
- Contact their local retail pharmacy about delivery services
- Fill out their medications at pharmacies with drive-through pick-up locations
- Fill extended day supply of maintenance medications
As a reminder, WGAT will be suspending prescription fill/refill limitations and refill waiting periods to allow enrollees to order a 90-day supply.
How long will these new prescription drug policies be in effect?
WGAT will continue to monitor the situation and will keep you updated on any changes that may occur. Our goal is to ensure all members have access to quality pharmacy benefits.
WGAT is here for you.
Our customer service team is on hand and ready to assist you, Monday through Friday, 7:00 a.m. to 5:30 p.m. P.T. at 800.777.7898. If you are unable to call during business hours, our automated system is available 24 hours a day, seven days a week and offers quick and convenient access to frequently requested information.