Frequently Asked Questions

In a Preferred Provider Organization (PPO), a network of health care providers contracts with a specific health plan to provide discounted health care services to people covered by the plan. The providers are known as Preferred Providers, and include physicians, hospitals, and other medical professionals. When participants use Preferred Providers, they enjoy maximum insurance benefits. When non-network providers are used, participant's benefits are reduced, which may result in higher out-of-pocket expenses.

Prevea Health Network is a preferred provider organization (PPO) offering access to physicians, hospitals, clinics and other health care professionals throughout Northeast Wisconsin. This network of outstanding medical professionals delivers services in a cost-efficient manner resulting in lower out-of-pocket costs to employers, employees and their families through their health benefit plans. If your provider of choice is not participating with Prevea Health Network, you can still see them, but the cost savings won't be as great and you may have greater out-of-pocket expense.

First, verify your benefit levels when using a Prevea Health Network provider. This information is available from your company's benefit office, health insurance carrier, or the claims administrator listed on your health coverage ID card. Your individual plan may require co-pays or deductibles, even when seeing an in-network provider. These costs, however, are often much less than you would pay when going to a non-PHN provider.

Confirm that the provider is participating with Prevea Health Network. You can either visit our online provider listing [LINK] or call PHN's provider verification line at (866) 640-7444 or (920) 272-1100.

It's crucial that you confirm in advance whether the provider you wish to see is participating with PHN. A provider may state they will accept PHN members, but they may not be a participating PHN provider. While you can still make an appointment with this physician, the medical claims will be considered "out-of-network" and you will have a larger out-of-pocket expense for this visit. Remember, you are responsible for all costs not covered by your healthcare plan.

Next, schedule your appointment by calling the specific provider.

THE DAY OF YOUR APPOINTMENT: Please show your health coverage ID card every time you register at your physician's office or hospital. The card identifies you as a participant in Prevea Health Network and contains information for the physicians and hospitals regarding your benefits. You will be asked to pay any office visit co-payments at the time of service.  

Prevea Health Network is not an insurance company. It is a network of medical providers. It does not determine eligibility or any benefit levels. Your insurance plan determines which services and who are covered, and at what levels.

Eligibility and coverage information is available from your company's benefit office, health insurance carrier, or the claims administrator listed on your ID card. Always understand your level of benefits before going to the doctor. 

Some services received at a Prevea Health Network hospital or from a Prevea Health Network physician may not be considered as "in-network" or PPO. Hospitals may subcontract services such as anesthesiology, pathology, radiology and emergency room services to independent, non-PPO providers. Likewise, physicians often utilize non-PPO providers for laboratory and diagnostic services. Under these circumstances, the PPO level of benefits may not apply. Make sure to ask all of your providers to use Prevea Health Network providers whenever possible.

Remember, you are responsible for all costs not covered by your healthcare plan.

Prevea Health Network allows you see any provider within the PHN network at any time. No referral is required. Make sure you verify that the services you are seeking are covered by your insurance plan before making your appointment.

A primary care provider (PCP) is a practitioner practicing in Family Practice, General Practice, Internal Medicine, OB/GYN or Pediatrics. It is important to have a PCP who knows your unique health needs based upon your individual lifestyle.

A specialty care physician is a physician that practices in a specific field of medicine, such as Orthopaedics or Ear, Nose & Throat. A referral from a primary care physician may be needed in order to see a specialty care physician.

In general, it is good practice to see a primary care practitioner first to determine whether you need to visit a specialist. However, you may call a specialist and arrange an appointment without a referral. Please check to see if your specialist is included in Prevea Health Network in order to obtain the highest level of benefits.

The provider will submit your bill directly to your insurance carrier or claims administrator for processing. If you receive a bill directly from a provider, contact the provider's business office. Advise them you are a network participant and ask that the bill be sent to your insurance carrier or claims administrator for processing. The address will be on your plan ID card.

A non-PPO provider may bill you directly. You may be responsible for forwarding the bill to your company's insurance carrier or claims administrator.

You will receive an Explanation of Benefits (EOB) from your insurance carrier or claims administrator. The EOB will outline how the claim was paid and what amounts, if any, are due to the health care provider. A copy of the EOB is also sent to the provider. The provider will bill you for the amount, if any, that may be your responsibility.

For general information about Prevea Health Network or for help in locating a provider, call Prevea Health Network at 1-866-640-7444 or (920) 272-1100 or e-mail preveappoinfo.com. For benefit coverage or claims questions, contact your company's benefit office, health insurance carrier or claims administrator.