Healthcare after employer coverage ends in Kimberly

Start with the care you need—not a billing maze

SakeOf is a healthcare membership designed to make everyday care and medical bills easier to approach. The practical sequence is simple: use an appropriate low-friction care option first, choose local care when an in-person service is needed, and turn to SakeOf advocacy when a bill or larger medical event needs a closer look.

Your available services depend on the membership options you select and keep active, and program rules apply. The calculator and Savings Guide can help you explore options; Jordan can help you understand how the membership works before you choose.

Use everyday care options for the right situation

For a common, non-emergency illness or symptom that is appropriate for a virtual visit, Zero Copay Telemedicine can provide access to a telemedicine consultation. The current service partner does not set a program limit on consultation frequency or duration. Availability, technology, clinical appropriateness, state law, and prescribing rules still apply.

If a clinician recommends a prescription, Rx and Prescription Benefits may help with prescription access under the active Rx program. The cost of a prescription follows that program, and a medication’s availability or cost should be checked through the relevant service. A telemedicine recommendation may also lead to separate care needs—such as a lab, imaging, specialist, or in-person follow-up—which are not included simply because the virtual visit recommended them.

When active, Mental Health and Counseling can offer problem assessment, supportive counseling, follow-up when available, crisis support, and referrals when more care is needed. Virtual Primary Care is a separate direct-service option with a dedicated physician relationship, ongoing virtual follow-up, an annual virtual wellness visit, health-risk assessment, and care coordination. It can also support medication review and chronic-care follow-up when appropriate for virtual care. Its current bundled tier requires Rx and Prescription Benefits, Zero Copay Telemedicine, and Mental Health and Counseling to remain active.

Choose in-person care near Kimberly when it is needed

Official sources reviewed for this guide identify healthcare resources serving Fayette County, rather than a verified healthcare facility located in Kimberly itself. The Fayette County Health Department is listed at 5495 Maple Lane in Fayetteville, with weekday hours of 8 a.m.–4 p.m.; call to confirm current services before making the trip.^bms.wv.gov Its website describes services including screenings and vaccinations, but offerings and availability should be confirmed directly.

State listings identify New River Health Association in Scarbro as a primary-care center and federally qualified health center, and list AcessHealth Fayette Clinic and Meadow Bridge Clinic as county satellite clinics. Call to verify each clinic’s current address, services, appointment availability, and accepted payment arrangements before traveling. These listings are starting points for provider search, not confirmation of a specific appointment or payment arrangement.

For hospital care, CAMC Plateau Medical Center is listed as an active critical access hospital at 430 Main Street in Oak Hill; its listed phone is 304-469-8600. Ask the facility for a written estimate for the specific service and whether separate professional or ancillary charges may apply. Prices and payment arrangements are not established by the local listings.

For public-program questions, the Fayette County Department of Human Services office in Oak Hill lists Medicaid, WVCHIP, and non-emergency medical transportation among its family assistance services. WV PATH provides screening and applications for programs including Medicaid and WVCHIP, while the state Medicaid provider search can help you check provider information. Confirm eligibility, benefits, transportation details, and provider participation directly through the relevant program or provider.

Put bill review and advocacy to work

If an in-person visit, test, procedure, or hospital service produces a confusing bill, SakeOf Full Service advocacy can help with bill verification, fair-price review, and negotiation support. The goal is to help members examine charges and understand the next steps—not to assume that every charge will be changed or that every service is eligible.

Keep itemized bills and provider documents. Submissions require an itemized bill with service dates, provider information, and CPT or HCPCS codes when available. SakeOf may request clinical notes, medical records, billing details, or a signed release to review eligibility, medical necessity, and fair pricing. Complete documents are due within six months of the service date; balance bills, denials, or payment demands should be submitted within 10 days of receipt.

Understand support for larger eligible medical events

For a larger eligible event, the applicable member commitment is part of the process. After the commitment and other program requirements are addressed, voluntary community funding may be available for eligible expenses. Eligibility and any funding are subject to the Program Guide and review; do not assume a particular bill or amount will be shared.

When planning a service, ask the provider for a service-specific estimate and whether facility, professional, lab, imaging, or other ancillary charges may be billed separately. For hospital price information, CMS explains hospital price-transparency resources; an estimate may not represent the final bill.^www.cms.gov

Explore options that fit other care needs

If pregnancy planning is relevant, the maternity feature has a continuous 12-month waiting period that must be completed before pregnancy begins. Eligible maternity expenses can include routine prenatal care, medically necessary tests and ultrasounds, delivery, and routine pregnancy-related postpartum care through six weeks, subject to program limits and rules. Adding or restoring the feature after conception does not make that pregnancy eligible.

Other membership options may include dental and vision discounts, chiropractic or acupuncture, physical or occupational therapy, and durable medical equipment, when selected, active, and eligible under the applicable program rules. For PT/OT under that feature, the limit is 12 visits and a $780 annual maximum shared across the enrolled membership; the feature-specific member responsibility is $35 for eligible visits. Check current membership details for the rules that apply to each option.

Take a useful next step in Fayette County

• For everyday symptoms: Check whether Zero Copay Telemedicine is active and whether your concern is appropriate for a virtual visit. Emergencies need emergency care.
• For an in-person visit: Use provider search, then call the clinic or facility to confirm location, service, appointment availability, payment arrangements, and an estimate.
• For Medicaid or WVCHIP questions: Start with WV PATH or contact the Fayette County Department of Human Services office in Oak Hill.
• For a bill or larger event: Review the Program Guide and send required documents to SakeOf within the stated timeframes.
• To compare membership options: Use the calculator or Savings Guide, ask Jordan questions, and review enrollment options.