Carelon member and patient support
Find links to services, resources, and important phone numbers to help you manage your care.
Are you a provider? Access your services here.
Quick links to the services you use most
Whether you’re looking for how to refill a prescription or find a provider, we can guide you to the information you need.
Access your account, health information, care teams, and tools related to your Carelon services.
Order refills, check pricing, and manage your medications.
Find a behavioral health provider
Search for behavioral health providers in your plan’s network.
Did Carelon contact you?
If you received a call, letter, email, or text from Carelon, it may be related to palliative care support or a subrogation questionnaire. Use the links here to learn why we contacted you, find forms, and take next steps.
If you prefer to speak to someone by phone for palliative care services, please call 844-232-0500.
To speak to someone by phone for information about a subrogation request, please call the number listed on the subrogation letter you received. Alternately, you can contact the Member Services number on your member ID card or refer to the member support contact information provided by your health plan.
Palliative Care
If you were referred to Carelon for palliative care, we may reach out to better understand your health, symptoms, and care needs.
Subrogation Questionnaire
If Carelon reached out about a Subrogation request, we need additional information to understand if someone else should be financially responsible for your treatment.
Find the support you need
Select from the list of Carelon services below to find forms, resources, and additional information.
Behavioral health
If you are experiencing a mental health, suicide, or substance use crisis, call or text 988. If you or someone else is in immediate danger or needs urgent medical care, call 911.
For mental health, substance use, or other specialized care needs, Carelon offers compassionate support and practical resources tailored to you. We can help you build resilience, move forward with confidence, and navigate care with specialized providers for conditions such as autism spectrum disorder, eating disorders, and serious mental illness.
Use our plan lookup tool to find resources specific to your health plan.
Find available providers in your plan’s network.
To speak with a representative, please call the Member Services number on your member ID card or refer to the member support contact information provided by your health plan.
Medical benefits management
Frequently asked questions (FAQs)
How are requests for clinical appropriateness review initiated with Carelon Medical Benefits Management?
Your care provider can initiate a request for clinical appropriateness review by contacting Carelon Medical Benefits Management at the phone number indicated on the back of your health plan ID card.
Which services require review?
The lists differ depending on the health plan. Your member materials from the health plan (usually the member handbook or the health plan’s website) should have the list of services that require approval. If you have additional questions about which services require approval under a Carelon Medical Benefits Management program, please contact the number on the back of your health plan ID card for your health plan’s member services department.
Can I see if a utilization review request has already been processed?
Your care provider is responsible for providing information about you and your health history to Carelon Medical Benefits Management to review the request. Carelon Medical Benefits Management talks directly with your care provider, as he/she is responsible for the care that you receive. If you have a question about whether Carelon Medical Benefits Management has approved the request, please contact your care provider.
How can I receive a copy of the clinical criteria used by Carelon Medical Benefits Management?
The clinical guidelines developed by Carelon Medical Benefits Management are available on our website at: https://guidelines.carelonmedicalbenefitsmanagement.com .
Who makes the decisions on the requests?
If our staff cannot approve a request, a doctor reviews the information provided by your care provider to confirm the decision. For further consultation, your care provider is given an opportunity to speak with the Carelon Medical Benefits Management doctor. If, after discussing with your care provider and reviewing the information, the service cannot be approved, the Carelon Medical Benefits Management doctor makes the final decision.
How do I know when the service is not approved?
When Carelon Medical Benefits Management makes a decision that your condition and history does not require the service requested, you are notified of the decision in a letter. Your care provider also receives a copy of the letter that explains why the service was not approved.
How can I find appeal information if a request is denied?
When Carelon Medical Benefits Management determines that your condition and history do not support the requested service, you are notified of the decision in a letter, as previously described. This letter provides information on how to appeal the decision made by the Carelon Medical Benefits Management doctor.
Palliative care
Our palliative care program supports patients and caregivers by focusing on comfort, emotional well-being, and health goals at any stage of a serious illness. We're here to answer questions and provide support 24/7.
To speak with a member of our support team, call: 844-232-0500
Pharmacy
Whether you use a local pharmacy or infusion center or have prescriptions delivered to your door, we can help you manage your medications and enhance your health.
CarelonRx: Go to carelonrx.com/login . Please note: Anthem and Wellpoint drug plan members should log in to manage medications via Sydney® Health.
BioPlus Specialty Pharmacy: Go to bioplusrx.com/contact
Paragon Healthcare: Visit paragonhealthcare.com/contact-us
Subrogation
If Carelon Subrogation has contacted you, it means your health plan asked us to review a medical claim to see if someone else should be responsible for covering the cost of the care you received. We need your help completing a short questionnaire so we can gather the information needed to evaluate the claim.
For more information about a subrogation request, call the number listed on the subrogation letter you received. You can also contact the Member Services number on your member ID card or use the member support contact information provided by your health plan.