a Going to the Doctor | WPS Health   
Customer Resources

Customer Resources



Going to the Doctor


WPS Health Plan encourages customers to select a primary care practitioner (PCP) to coordinate their overall medical care. You may already use a participating PCP for your health care, and you can simply designate that PCP on your enrollment form. Otherwise, you may choose a PCP for yourself and each family member at the time of enrollment.

You can change your PCP at any time. If you want to do so, call Customer Service at the number found on the back of your ID card or, mail completed form to WPS Health Plan. Although you can change your PCP at any time, we encourage you to establish a relationship with one doctor.

Before you visit any provider or facility, we recommend you call ahead to confirm their network status, address, office hours, and that they are accepting new patients.

When you’re not feeling well, it is hard to wait until tomorrow for an appointment. Many of our participating providers have extended hours and are available evenings, weekends, and on holidays. Please give your doctor’s office a call if you have a question about a minor injury, illness, or other concern. One of their health care professionals will answer your medical questions and help you decide if you need to see a doctor immediately or if you should schedule an appointment with your primary care practitioner. They may also offer self-care treatments that can be done at home to increase comfort and speed recovery.

A Primary Care Practitioner (PCP) is a participating provider who practices internal medicine, family practice, general practice, pediatrics, or obstetrics and gynecology. A PCP can assure that patients who receive comprehensive, continuous, and coordinated care from a doctor they know and trust experience more timely screenings, faster and more accurate diagnoses, more effective treatments, and fewer adverse drug interactions.

The result: Better health and greater satisfaction with your care, which is why WPS promotes healthy relationships between our customers and a PCP.

Primary Care Practitioner (PCP) Form - Coming Soon

In the event your PCP or specialist leaves our network, there are certain circumstances that allow you to continue to receive care from that provider. Please refer to your certificate of insurance or individual policy for further details on how continuity of care may apply.

An in-network provider is one who has contracted with WPS to provide services to our customers for specific pre-negotiated rates. An out-of-network provider is one who has not contracted with WPS. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, WPS will either pay less or not pay anything for services you receive from out-of-network providers.

At the written request of our customers, WPS will provide a good faith estimate of the reimbursement that will expect to pay and the customer’s responsibility (out-of-pocket costs) for a specified health care service that is being considered. This process does not take the place of a preauthorization, prior approval, or precertification.

Please be aware that any requested preservice estimate is a verification of benefits and not a guarantee of payment. Payment is based on the terms, conditions, and provisions of the policy/plan and is subject to the usual, customary, or contracted rates that are in effect at the time the service is preformed including, but not limited to:

  • Requirements for medical necessity
  • Prior authorizations
  • Precertifications
  • Exclusions for work-related injuries
  • Provider network affiliations
  • Pricing adjustments due to negotiated transplant coverage

Also, the estimate of out-of-pocket expenses that will be prepared are based on information submitted to Arise along with claims and benefits we have processed at the time of our inquiry response. Arise will assume no modifications or complications occur in the treatment plan.

View our out-of-pocket expenses forms

   

Is your doctor in your network?