Accessing Primary and Specialty Care

Customer Navigation

Accessing Primary and Specialty Care

WPS provides access to physicians and health care facilities you know and trust throughout Wisconsin. Your health care provider choices depend on which type of plan you choose.

Your health plan typically provides a higher benefit level when you use in-network providers, which means you will usually incur lower out-of-pocket costs. Use our convenient Find a Doctor tool to quickly and easily locate in-network health care providers in your area.

Remember that certain treatments or services may require prior authorization. Please see your policy for more detailed information on your health plan benefits.

PPO plans

With a Preferred Provider Organization (PPO) plan, you’re covered no matter which provider you choose. PPO plans cover in-network and out-of-network primary and specialty care.

HMO plans

A Health Maintenance Organization (HMO) plan requires you to seek health care from a participating provider. Out-of-network care is generally not covered, except in emergencies. If you wish to see an out-of-network provider, you must receive an approved prior authorization from WPS.

POS plans

Point-of-Service (POS) plans encourage the use of participating providers. Out-of-network care is covered, but typically at a lower benefit level, which increases your out-of-pocket costs.

Helpful Forms

A prior authorization is the process of receiving written approval from WPS for certain services or products prior to services being rendered. The prior authorization is a written form submitted to us by a participating provider. Services are still subject to all plan provisions including, but not limited to, medical necessity and plan exclusions. See our WPS Explains Videos for more information on prior authorizations.

It is ultimately the customer’s responsibility to make sure prior authorization requests are submitted and approved by WPS prior to receiving services. If you have any questions, please call our Customer Service Department

Usual and Customary (U&C) fee levels will apply to services provided by non-participating providers. This means that you are responsible for any charge that exceeds the U&C fee level for authorized services received from non-participating providers

For HMO plans: before you receive treatment from a non-participating provider, you must receive an approved prior authorization from WPS.


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