Network access and adequacy ensure that in most cases you have reasonable access to a sufficient number of in-network providers within your geographic area, so you can get the healthcare you need without unnecessary delays or travel. We strive to make it easy for our members to utilize our network of contracted providers.
The West Virginia Health Benefit Plan Network Access and Adequacy Act, W.Va. Code § 33-55-1 et seq., requires insurers to maintain a network of health care providers for its insureds to ensure that the network is sufficient in numbers and has appropriate types of providers in order for all covered services to be accessible without unreasonable travel or delay. If an insurer cannot meet network adequacy standards, they must have a process to ensure covered individuals receive benefits from out-of-network providers at in-network levels. To learn more about how Highmark WV complies with this mandate and to view Highmark WV’s Network Access Plan, please click on the link below.
We have designated staff to assist you in finding a Participating Provider who can treat your mental health condition or substance use disorder. You may contact our designated staff by calling 1-888-697-8695.
If there is not a Participating Provider available within the appointment wait time who can treat your mental health condition or substance use disorder, you or your designee may submit an Access Complaint to us by calling 1-888-697-8695, by writing to us at P.O. Box 15068, Albany New York 12212, or electronically by visiting our website.
If you have questions about your benefits, please call the number on the back of your member ID card or log in to your account.
