Health insurance
Health insurance coverage can be complex. We’re here to walk you through insurance and financial options.
The first step when seeking medical care is checking on insurance coverage by calling the phone number on your insurance card to verify your benefits and learn which providers, clinics or hospitals are within your insurance network. Prevea partners with most health care insurance companies, participates in Medicare and assistance programs, and offers tools to estimate your costs before care.
If you have any questions regarding your Prevea bill or need financial assistance, our financial service representatives are available Monday – Friday, 8 a.m. to 4:30 p.m. Call (920) 496-4775 or (888) 477-3832, or send us a message through MyPrevea.
Self-pay
If you do not have insurance or choose to not use your insurance, this is called self-pay and you are required to pay upfront for your care at the time of your appointment.
- For office visits, you will be required to pay a minimum of $150 at the time of each visit. If your office visit involves any X-ray services (including mammograms), you will be required to pay a minimum of $225 at the time of each visit. In either case, you will be billed for any remaining cost, and all balances are due within 30 days after you receive your first billing statement.
- For elective surgeries, you will be required to pay a minimum of 40% of the total cost before the surgery is scheduled. Any required pre-payment must be received at least 15 days prior to the service. Depending on the form of payment used, the pre-payment must clear before the surgery is scheduled.
- If you need surgery immediately, you may pay in full before the procedure or within 15 days of the surgery. If you cannot pay within 15 days of your surgery, you will need to contact Patient Accounts at (920) 496-4775 or (888) 477-3832, to arrange payment.
Insurance coverage and networks
If you have health insurance, it’s important to find out what health centers and providers are in-network with your insurance plan. Choosing health care clinics, hospitals and doctors that are included in your insurance network ensures certain costs are covered. You are responsible for confirming if the care you are planning to receive is “in-network” with your insurance plan. Before scheduling an appointment, contact your health insurance company to verify benefits and learn which clinics or hospitals are within your insurance network.
- Health care organizations, physicians and providers are considered “in-network” when they have an agreement with your health insurance plan. This means the organization has a contract with the insurance company, which leads to savings and/or discounts on services for patients. This can also be called “participating providers.” Information on which providers and organizations are in-network for your insurance plan is available from your insurance company.
- If your insurance plan does not include a provider or health center, they are considered “out-of-network.” In this case, the patient is often responsible for the full amount billed for the service they receive. Some health insurance plans cover both in-network and out-of-network care, but in-network care is often still more cost-effective for patients.
- For some specific circumstances, such as if you are seeing a specialist, even if the provider you would like to see is in-network with your insurance plan, your insurance company may require a referral from another provider, pre-certification or prior authorization to cover the cost of the services. Please contact your insurance company before scheduling an appointment with a specialist.
Prevea partners with most insurance companies, to be included “in their network,” allowing you to access care at our health centers and partner hospitals at the highest benefit level.
- Anthem Blue Cross and Blue Shield (excludes WI Blue Pathway, WI Blue Priority & WI Blue Priority X)
- Centivo
- 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
- Molina
- Multiplan Network
- Network Health
- Prevea 360/Dean Health Plan (DHP) (excludes some DHP plans)
- Security Health Plan (SHP) (excludes some plans)
- 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)
- Anthem Blue Cross Blue Shield
- Chorus 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 Medicaid (formerly My Choice Wisconsin)
- Security Health Plan (SHP) (BadgerCare Plus and Medicaid SSI)
- UnitedHealthcare Community Plan (BadgerCare) (excludes United Hearing)
- Anthem Blue Cross Blue Shield
- Devoted Health, Inc.
- Humana
- iCare
- Molina (includes former My Choice Wisconsin plans)
- Network Health Plan
- Security Health Plan (SHP) (excludes Promise RX, Surety RX)
- United HealthCare (UHC) (excludes United Hearing)
- 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)
- 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)
- Dean Health Plan/Prevea360
- Network Health Plan
- Security Health Plan (may exclude some plans)
- CorVel (does not include all locations, check with the insurance company for details)
- OccuNet (Green Bay Packers & UW Green Bay Injured Athletes only)
- Trilogy
- 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 employees only) (does not include all locations, check with the insurance company for details)
- 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
Pre-certification and prior authorization
Some insurance plans require prior approval before seeking care for certain services. This is called pre-certification or prior authorization. Please contact your insurance company directly to find out if you need pre-certification for your care. Prior authorization confirms a service is deemed medically necessary by an insurer, but does not guarantee final payment or coverage. Patients are responsible for costs if certain services are not pre-certified.
Insurance claims
Prevea Health gladly files claims on your behalf by sending your insurance company a detailed explanation of what services you received and how much they cost.
- After your insurance company reviews the claim, they determine what services are covered under your plan and calculate how much they will pay versus how much you will be responsible for paying. You may receive an "Explanation of Benefits" (EOB) from your insurance company that shows what insurance paid and what you will owe before you receive your bill. An EOB is not a bill. You will receive a billing statement from your provider (i.e. Prevea Health). Get more information about billing and statements, including why you might receive more than one statement.
- We must file claims exactly as services are performed per federal laws; we cannot change claims. If coverage is denied, you are responsible for charges.
- We will 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.
- Annual physicals are considered “preventive care” claims by most insurers. If new or existing health conditions are discussed during a preventive visit, your insurance may bill it as an additional diagnostic visit. Learn more.
Expenses associated with insurance
There are several expenses to consider when it comes to insurance.
Please check with your insurance company before your appointment so you know if you have a co-payment and come prepared to pay it at the time of service. Cash, check, debit or credit card can be used to pay co-payments required by your insurance. FSA and HSA accounts are also accepted.
HSAs (Health Savings Accounts) and FSAs (Flexible Spending Accounts)
Health Savings Accounts (HSA) and Flexible Spending Accounts (FSAs) are special accounts that can be used to pay for approved medical expenses. These accounts let you set aside money to pay for health care services, deductibles, co-payments, coinsurance and other approved expenses. If your insurance plan offers an HSA and/or FSA, they will also outline which health care expenses are approved and can be paid for using these accounts. Check with your health insurance company to learn more about these accounts.
Know your health care costs
One of the biggest questions you might have when seeking medical care is, “How much is this going to cost?” The best way to find out what your medical care is going to cost is to request an estimate before your appointment. There are a few ways to do that.