Prevea Health

Insurance


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 8:00 a.m. to 5:00 p.m., Monday through Friday, to answer questions about your account. Send us a mesage through MyPrevea or Chat with us in the bottom right hand of your screen. 
 

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 Health Insurance Plans:
  • Anthem Blue Cross and Blue Shield (excludes WI Blue Priority & WI Blue Priority X, except for Prevea Western locations)
  • Aspirus Health Plan (Aspirus employee plan only)
  • Centivo (East WI locations only)
  • Children’s Community Health Plan
  • Choice Care Network
  • CIGNA (excludes HealthPartners Robin)
  • Coventry HealthCare (excludes Aetna for HSHS St. Nicholas Hospital only)
  • First Health Network (excludes Aetna for HSHS St. Nicholas Hospital only)
  • Group Health Cooperative of Eau Claire
  • HealthEOS Network (excludes Aetna for St. Nicholas Hospital only)
  • HealthPartners (Prevea Western only)
  • Health Payment Systems
  • HealthSmart/Interplan Health Group
  • Humana (includes HPN Network for HSHS St. Nicholas Hospital only)
  • Live360 (HSHS Health Plan)
  • Medica (excludes Mayo Medical Plan, Medica CompleteHealth & Engage by Medica)
  • Molina (excludes Prevea Western)
  • Multiplan Network
  • Network Health (excludes Prevea Western)
  • PreferredOne Network (Prevea Western locations only)
  • Prevea 360/Dean Health Plan (DHP) (excludes some DHP plans)
  • Quartz (Prevea Western locations only)
  • Security Health Plan (SHP) (excludes Affirm HMO/POS, Discover, Enrich, Inspire,
  • Simplyone ACA/HMO/POS/SAS HMO)
  • SelectCare-LaborCare Network (Prevea Western locations only)
  • Sheboygan Employer Health Network (SEHN) (excludes Prevea Western locations)
  • The Alliance
  • The Employer Coalition of Wisconsin (Rice Lake School District only - Prevea Western locations only)
  • Three Rivers Provider Network (excludes Prevea Western locations)
  • Trilogy Health Network (excludes Prevea Western locations)
  • United HealthCare (UHC)
  • WEA Insurance Corporation (excludes Mayo plans)
  • WPS (excludes Select/Select Plus)

Medicaid Contracts
  • Anthem Blue Cross Blue Shield
  • Children’s Community Health Plan
  • Group Health Cooperative of Eau Claire (BadgerCare Plus and Medicaid SSI)
  • HealthPartners (MN Medicaid - Prevea Western only)
  • iCare
  • Managed Health Services (MHS) / Network Health Plan (BadgerCare Plus and Medicaid SSI)
  • Medica (MN Medicaid - Prevea Western only)
  • My Choice Wisconsin (formerly Trilogy Medicaid – excludes Prevea Western)
  • Molina (excludes Prevea Western)
  • Quartz (Prevea Western locations only)
  • Security Health Plan (SHP) (BadgerCare Plus and Medicaid SSI)
  • UnitedHealthcare Community Plan (BadgerCare)

Medicare Contracts
  • Anthem Blue Cross Blue Shield (excludes Prevea Western locations)
  • Dean Health Plan/Prevea360
  • Group Health Cooperative of Eau Claire I-SNP (Prevea Western locations only)
  • HealthPartners (Prevea Western only)
  • Humana
  • iCare
  • Medica Prime Solution Medicare (Medicare Cost Plan only for Prevea Western only)
  • Molina (excludes Prevea Western)
  • My Choice Wisconsin SNP (excludes Prevea Western)
  • Network Health Plan (excludes Prevea Western locations)
  • Quartz (Prevea Western locations only)
  • Security Health Plan (SHP) (excludes Promise RX, Surety RX)
  • Today’s Option/Universal American (Prevea Western locations only)
  • UCare (Prevea Western locations only)
  • United HealthCare (UHC)
      
Family Care Contracts
  • My Choice Wisconsin (formerly Care Wisconsin First)
  • Inclusa (formerly Community Link, Inc, Community Care Connections of Wisconsin, ContinuUs and Western Wisconsin Cares)
  • Lakeland Care, Inc. (Prevea – Curative Connections location only)

Health Insurance Marketplace - For Individuals
  • Children’s Community Health Plan
  • Dean Health Plan/Prevea360
  • Molina Healthcare (excludes Prevea Western)
  • Security Health Plan

SHOP Marketplace​ - For Small Businesses
  • Children’s Community Health Plan
  • Dean Health Plan/Prevea360
  • Molina Healthcare (excludes Prevea Western)
  • Security Health Plan

Worker's Compensation
  • CorVel
  • Coventry/First Health
  • HealthEOS/MutliPlan (Prevea Western only)
  • Trilogy (excludes Prevea Western locations)
 
Vision
  • EyeMed Vision (Prevea Health Manitowoc and Kohler locations only)
  • Superior Vision (Prevea Eastern WI locations only)
  • VSP Vision (includes Kohler and HSHS employees only)
 
Other
  • Family Health Center, Inc. (Prevea Western locations only)
  • Immergrun (Prevea Western locations only)
  • Naphcare
  • United Behavioral Health/Optum (excludes Prevea Western)
  • Plain Communities of Central WI (Prevea Western locations only)
  • VA – Optum (medical and behavioral health with referral only)
  • Wisconsin Dept. of Justice Crime Victim
  • WI Well Woman Program (St. Vincent Hospital dba Prevea Health only)

 

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.