Insurance and financial assistance
Many health care services provided at Prevea Health are covered by health insurance policies. We gladly file claims on your behalf. Prior to scheduling an appointment, verify your benefits and confirm whether or not the provider and/or hospital are within your insurance network.
Federal laws require health care providers to submit every insurance claim accurately, reporting the exact services performed and the reason for performing them. Prevea Health cannot change this information so that your claim will be paid. For example, Prevea Health physicians recommend that patients have an annual physical exam to evaluate their overall health. Your insurance company may consider this physical to be “routine” or “preventive.” A physical exam is for the sole purpose of preventive care and is not problem focused (i.e., a sore knee) and cannot involve a chief complaint or current illness. If during a routine or preventive physical you discuss a new condition or a change in an existing condition that requires additional consultation or lab work, you may be billed for a diagnostic office visit. This may result in your insurance company charging you an additional co-pay/deductible/co-insurance, etc.
Prevea Health does not bill any third-party liability carriers. We will bill your health insurance company, and if charges are denied, they become the responsibility of the person named on the account.
For the most efficient resolution to any disputed or unpaid claims, work directly with your insurance carrier. All accounts are due within 30 days after you receive your first statement. If needed, Patient Accounts Representatives are available at (920) 496-4775 or toll free (888) 477-3832 from 7:30 a.m. to 5:30 p.m., Monday through Friday, to answer questions about your account.
Billing
Insurance
Medicare and Medicare Advantage
Price estimates and transparency
Pre-certification or Prior Authorization
Please verify whether or not your insurance coverage requires pre-certification or prior authorization for services by contacting your insurance company directly. Patients may be considered financially responsible for any services not pre-certified or prior authorized in accordance to their insurance plan provisions.
Good Faith Estimate
If you do not have insurance or are not using insurance, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Click here for more details.
Insurance Networks
We understand that selecting the right health plan is important. These partnerships provide coverage for providers and services at our Prevea health centers and our partner hospitals.
Commercial Insurance Contracts
- Anthem Blue Cross and Blue Shield (includes Blue Preferred Broad Marketplace Plan; excludes WI Blue Priority & WI Blue Priority X)
- Centivo
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Choice Care Network
- CIGNA (excludes HealthPartners Robin)
- First Health Network (excludes Aetna for Sheboygan County)
- Group Health Cooperative of Eau Claire
- HealthEOS Network (excludes Aetna for Sheboygan County)
- Health Payment Systems (East WI locations only)
- HealthSmart/Interplan Health Group
- Humana
- Live360 (HSHS Health Plan)
- Molina
- Multiplan Network
- Network Health
- Prevea 360/Dean Health Plan (DHP) (excludes some DHP plans)
- Security Health Plan (SHP) (excludes Affirm HMO/POS, Discover, Enrich, Inspire, Simplyone ACA/HMO/POS/SAS HMO)
- Sheboygan Employer Health Network (SEHN)
- The Alliance
- Three Rivers Provider Network (does not include all locations, check with the insurance company for details)
- Trilogy Health Network
- United HealthCare (UHC) (excludes United Hearing, Advocate Aurora Health, Nexus ACO and United Exchange Plans)
- Wheaton Health Network (does not include all locations, check with the insurance company for details)
- WPS (excludes Select/Select Plus)
Medicaid HMO/SSI Managed Care Contracts
- Anthem Blue Cross Blue Shield
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Group Health Cooperative of Eau Claire (BadgerCare Plus and Medicaid SSI)
- iCare
- Managed Health Services (MHS) / Network Health Plan (BadgerCare Plus and Medicaid SSI)
- Molina
- My Choice Wisconsin (formerly Trilogy Medicaid)
- Security Health Plan (SHP) (BadgerCare Plus and Medicaid SSI)
- UnitedHealthcare Community Plan (BadgerCare) (excludes United Hearing)
Medicare Advantage Contracts
- Anthem Blue Cross Blue Shield
- Devoted Health, Inc.
- Humana
- iCare
- Molina
- My Choice Wisconsin
- Network Health Plan
- Security Health Plan (SHP) (excludes Promise RX, Surety RX)
- United HealthCare (UHC) (excludes United Hearing)
Family Care Contracts
- Community Care, Inc. (does not include all locations, check with the insurance company for details)
- My Choice Wisconsin (formerly Care Wisconsin First, does not include all locations, check with the insurance company for details)
- Inclusa (formerly Community Link, Inc, Community Care Connections of Wisconsin, ContinuUs and Western Wisconsin Cares)
Health Insurance Marketplace - For Individuals
- Anthem BCBS Blue Preferred Broad Marketplace (excludes Blue Priority X and Blue Priority WI)
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Dean Health Plan/Prevea360
- Molina Healthcare
- Security Health Plan (excludes Enrich (HMO/POS), Simplyone ACA/HMO/POS/SAS HMO)
SHOP Marketplace - For Small Businesses
- Anthem BCBS Blue Preferred Broad Marketplace (excludes Blue Priority X and Blue Priority WI)
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Dean Health Plan/Prevea360
- Molina Healthcare
- Security Health Plan (excludes Enrich (HMO/POS), Simplyone ACA/HMO/POS/SAS HMO)
Worker's Compensation
- CorVel (does not include all locations, check with the insurance company for details)
- Coventry
- Trilogy
Vision (may be in-network for limited employer plans only for some payers)
- EyeMed (does not include all locations, check with the insurance company for details)
- Superior Vision (does not include all locations, check with the insurance company for details)
- VSP (HSHS & Kohler employees only) (does not include all locations, check with the insurance company for details)
Other
- Cigna Behavioral Health (does not include all locations, check with the insurance company for details)
- Naphcare
- United Behavioral Health/Optum VA
- VA – Optum (medical and behavioral health with referral only)
- Vivent Health (formerly Aids Resource Center of WI)
- Wisconsin Dept. of Justice Crime Victim
- WI Well Woman Program