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Insurance and financial assistance

Billing

Prevea offers several ways to pay a bill. If you have any questions regarding your statements or need financial assistance. Our financial service representatives are available to assist patients during normal business hours, Monday - Friday.

Cash pay option for therapy

In some situations, it may be less expensive to pay cash for therapy than to go through your insurance provider. Given that, it may be preferred to pay cash for physical, occupational and speech therapy, as well as for athletic training.

Medicare and Medicare Advantage

Prevea Health participates in Medicare and some Wisconsin Medical Assistance programs and is allowed to collect the required annual deductible, co-insurance and non-covered services from patients. Medicare only pays for covered items and services when Medicare guidelines are met.

Price estimates and transparency

Before your visit with a Prevea Health provider, you can use Prevea Price Estimate to obtain the approximate amount you might owe after insurance. Prevea offers several options to obtain a price estimate.

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.

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:

  • America's PPO/Today's Option
  • *Anthem Blue Cross and Blue Shield
  • Arise Health Plan
  • Care Wisconsin
  • Children's Community Health Plan
  • Cigna
  • Cenpatico
  • Community Care, Inc.
  • CorVel Corporation
  • EyeMed
  • Group Health Cooperative
  • Gunderson Health Plan
  • HealthEOS/Multiplan
  • Health Payment Systems, Inc.
  • Heartland Hospice
  • Humana/Choicecare
  • Independent Care Health Plan (iCare)
  • Integrated Health Plan
  • Interplan Health Group
  • Managed Health Services
  • Molina
  • Network Health
  • North Central Health Care Alliance
  • Optum
  • Prevea360 Health Plan
  • Security Health Plan
  • Sheboygan Employers Health Network (SEHN)
  • Superior Vision
  • Three Rivers Provider Network
  • Trilogy Insurance Company
  • Wheaton Health Network
  • UnitedHealthcare
  • VSP
  • Wisconsin Dept. of Justice Crime Victim
  • Wisconsin Education Association (WEA)
  • Wisconsin Physician Service (WPS)
  • Wisconsin Well Woman Program

 

Medicare Advantage Plans:*Anthem Blue Cross and Blue Shield

  • Humana
  • Molina Healthcare
  • Network Health Plan
  • Prevea360 Health Plan
  • UnitedHealthcare

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.

Find a provider

Prevea makes it easy to find the right physician for you and your family.