Healthcare after employer coverage ends in Falling Waters

Start with the care you need

SakeOf gives members a practical way to organize healthcare around the need in front of them. You can choose selected direct-service or discount features, decide which provider to visit, and get help navigating care and medical bills. Full Service adds advocacy, fair-price bill review, and voluntary community funding for eligible larger expenses under program rules.

That means you can begin with a straightforward question: do you need virtual guidance, an ongoing care relationship, a prescription, an in-person appointment, or help understanding a bill? Compare membership options with the calculator and Savings Guide. Provider search and Jordan can help you think through a care situation and identify a next step.

Use everyday-care options that fit your needs

Zero Copay Telemedicine is an optional feature for health concerns appropriate for a virtual visit. Rx and Prescription Benefits and Mental Health and Counseling are also optional features. Check your membership options to see what you selected and what is active, then confirm service details with the relevant provider or pharmacy.

Virtual Primary Care offers a dedicated physician relationship with ongoing virtual follow-up, an annual virtual wellness visit, and chronic-care follow-up and medication-management support when clinically appropriate for virtual care. The current service tier requires Rx and Prescription Benefits, Zero Copay Telemedicine, and Mental Health and Counseling to remain active. It adds $15 per month.

Mental Health and Counseling may include problem assessment, supportive counseling, follow-up, crisis support, and referrals to other behavioral-health resources when more care is needed. Psychiatry, inpatient behavioral health, emergency psychiatric care, neuropsychological testing, residential substance-use treatment, and medication costs are not included merely by selecting the counseling feature.

Other optional features include maternity care, chiropractic and acupuncture, dental and vision discounts, physical and occupational therapy, and durable medical equipment. Each feature has its own monthly adjustment. Review the calculator and your membership options to compare features with the services you expect to use.

Choose in-person care near Falling Waters

Falling Waters is in Berkeley County, and nearby Martinsburg offers several places to check when care calls for an in-person visit. WVU Medicine lists Spring Mills family-medicine and urgent-care locations in Martinsburg. Contact the location directly to ask about current hours, appointment availability, services, charges, and payment arrangements.

Berkeley Medical Center in Martinsburg provides emergency and specialty services. Its main number is 304-264-1000. For planned care, ask the hospital for an estimate specific to the service you expect and what the estimate includes. Posted standard charges can help you investigate costs, but they are not a personalized estimate or a final patient bill.

The Berkeley County Health Department lists clinical services including immunizations, family planning, and communicable-disease services. Call to ask about current hours, eligibility, appointment requirements, and fees. These are county resources in Martinsburg, not services located in Falling Waters.

SakeOf members choose their providers. For planned higher-cost care, contact SakeOf in advance when reasonably possible. Keep any estimate and ask the provider which facility, professional, laboratory, imaging, and other charges it includes.

Get advocacy and fair-price help with bills

Full Service includes advocacy and review of medical bills for eligibility, medical necessity, documentation, and fair pricing. SakeOf may negotiate or reprice a bill. This gives you a place to turn when a charge is unclear or you want support reviewing the records and pricing behind it.

Keep an itemized bill with service dates, provider information, and CPT or HCPCS codes when available. SakeOf may also request clinical notes, medical records, billing details, or a signed release. Submit complete documents within six months of the service date. Send balance bills, denials, or payment demands within 10 days of receiving them.

For a hospital service, request a service-specific estimate directly from the facility and save it with your records. WVU Medicine posts standard-charge information for Berkeley Medical Center; those files are a starting point for reviewing charges, not a personalized quote or a prediction of your final out-of-pocket cost.

Know how community support works for larger needs

For a larger medical event, Full Service brings together advocacy, fair-price bill review, and voluntary community funding for eligible expenses. The applicable member commitment and program rules shape how a request is considered. Keep your membership current, meet the applicable member commitment, and provide requested itemized bills and records.

Eligibility review may consider an illness, injury, symptom, diagnosis, or treatment that existed, was known, or was recommended or received during the 24 months before membership began—even if there was no formal diagnosis at the time. Final determinations depend on documentation, clinical review, and the Program Guide. If you are planning higher-cost care, contact SakeOf in advance when reasonably possible and ask what information to prepare.

Use local and state resources for your next step

For West Virginia Medicaid and WVCHIP applications, WV PATH is the state’s online portal for screening and applying. The Berkeley County Department of Human Services office handles services that include Medicaid, WVCHIP, and non-emergency medical transportation. The West Virginia Bureau for Medical Services also provides Medicaid member information, including resources about managed care, transportation, and renewals.

Choose the route that matches your situation: compare membership options with the calculator and Savings Guide, search for a provider, or ask Jordan to help you think through a planned visit, prescription, or bill. For a local appointment or public-health service, contact the Martinsburg provider or county department directly to confirm current details.