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
Commercial Insurance Contracts
- Anthem Blue Cross and Blue Shield (includes Blue Preferred Broad Marketplace Plan; excludes WI Blue Priority & WI Blue Priority X at East WI locations)
- Centivo (East WI locations only)
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Choice Care Network
- CIGNA (excludes HealthPartners Robin)
- First Health Network (excludes Aetna for St. Nicholas Hospital dba Prevea Health only)
- Group Health Cooperative of Eau Claire
- HealthEOS Network (excludes Aetna for St. Nicholas Hospital dba Prevea Health only)
- Health Payment Systems (East WI locations only)
- HealthPartners (West WI locations only)
- HealthSmart/Interplan Health Group
- Humana
- Live360 (HSHS Health Plan)
- Medica (West WI only; excludes Mayo narrow plans – Mayo Medical Plan, Medica CompleteHealth & Engage by Medica)
- Molina
- Multiplan Network
- Network Health (East WI locations only)
- PreferredOne (West WI locations only)
- 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) (East WI locations only)
- The Alliance
- The Employer Coalition of Wisconsin – Rice Lake School District (West WI only)
- Three Rivers Provider Network (SVG, SMG w/ Prevea East only)
- Trilogy Health Network
- United HealthCare (UHC) (excludes United Hearing)
- Wheaton Health Network (HSHS St. Nicholas Hospital only)
- WPS (excludes Select/Select Plus)
Medicaid 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)
- Medica (MN Medicaid – Western WI locations only)
- Molina
- My Choice Wisconsin (formerly Trilogy Medicaid – Eastern WI locations only)
- Quartz Health Plan (BadgerCare & SSI - Western WI locations only)
- Security Health Plan (SHP) (BadgerCare Plus and Medicaid SSI)
- UnitedHealthcare Community Plan (BadgerCare) (excludes United Hearing)
Medicare Contracts
- Anthem Blue Cross Blue Shield (Eastern WI locations only)
- Dean Health Plan/Prevea360
- Group Health Cooperative of Eau Claire (Western WI locations only)
- Humana
- iCare
- Molina
- My Choice Wisconsin (Eastern WI locations only)
- Network Health Plan (Eastern WI locations only)
- Security Health Plan (SHP) (excludes Promise RX, Surety RX)
- Today’s Option/Universal American (HSHS St. Nicholas Hospital only)
- UCare (Western WI locations only)
- United HealthCare (UHC) (excludes United Hearing)
Family Care Contracts
- My Choice Wisconsin (formerly Care Wisconsin First) (excludes St. Clare Memorial dba Prevea Health)
- 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
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Dean Health Plan/Prevea360
- Medica (not Mayo narrow plan – Engage by Medica) (West WI only)
- Molina Healthcare
- Quartz (West WI only)
- Security Health Plan (excludes Enrich (HMO/POS), Simplyone ACA/HMO/POS/SAS HMO)
SHOP Marketplace - For Small Businesses
- Anthem BCBS Blue Preferred Broad Marketplace
- Chorus Community Health Plan (formerly Children’s Community Health Plan)
- Dean Health Plan/Prevea360
- Medica (not Mayo narrow plan – Engage by Medica) (West WI only)
- Molina Healthcare
- Quartz (West WI only)
- Security Health Plan (excludes Enrich (HMO/POS), Simplyone ACA/HMO/POS/SAS HMO)
Worker's Compensation
- CorVel (excludes St. Clare Memorial Hospital dba Prevea Health)
- Coventry
- HealthEOS/MultiPlan (Western WI locations only)
- Trilogy
Vision (may be in-network for limited employer plans only for some payers)
- EyeMed (St. Vincent Hospital dba Prevea Health – Manitowoc location only & St. Nicholas Hospital dba Prevea Health Kohler location only)
- Superior Vision (St. Vincent Hospital dba Prevea Health & St. Nicholas Hospital dba Prevea Health only)
- VSP (HSHS & Kohler employees only) (St. Vincent Hospital dba Prevea Health & St. Nicholas Hospital dba Prevea Health only)
Other
- Family Health Center, Inc. – (Western WI locations outpatient services only)
- Immergrun (Western WI locations only)
- Cigna Behavioral Health (St. Vincent Hospital dba Libertas only)
- Naphcare
- Plain Communities of Central WI
- United Behavioral Health/Optum VA (Eastern WI locations only)
- 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 (Eastern WI locations only)