It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

Physicians Plus
(608) 282-8900 or (800) 545-5015
pplusic.com
Overall Quality Rating
See Report Card section
What’s New for 2013
Using care navigation, Physicians Plus will
help members access the best quality
health care at the best value. Our network
of over 200 primary care physicians will
work closely with members to manage
their overall health and access in-network
specialty care as needed. When out-ofnetwork
specialty services are needed
at centers of excellence — UW Hospitalowned
facilities, Children’s Hospital of
Wisconsin, Froedtert Hospital/Medical
College of Wisconsin and Mayo Clinic —
prior authorization will be required. Requests
for local care will be honored before outof-area
options are considered. Primary
care physicians at UW Health East, West,
University Station and Oakwood clinics will
no longer be available and specialty care
will require prior authorization.
Three new clinics, Meriter Fitchburg,
Stoughton and Dermatology, are now open
and available. Visit pplusic.com for more
information.
Provider Directory
Go to pplusic.com and click on Find a
Provider. To print the provider listing, select
State of Wisconsin Employees/WPE Directory.
To search for a provider, select State of
Wisconsin/Wisconsin Public Employee
(State/WPE) under the network drop-down
menu. Call member service at (608) 282-
8900 for a printed copy.
Referrals and Prior Authorizations
Prior authorization is not required for most
covered services delivered by Physicians
Plus network providers. Prior authorization
will be required for out-of-network specialty
services, including those at UW Hospitalowned
facilities and
our other centers
of excellence like
Children’s Hospital of
Wisconsin and Mayo
Clinic. Members
must have their
provider submit a prior
authorization request to
Physicians Plus before
receiving care from
Qualified Plan
Non-Qualified Plan
non-network providers.
See Glossary for definitions
Written decisions will be
provided to members
and providers for all requests.
Care Outside Service Area
Emergency and urgent care outside the
service area is covered when medically
necessary. Call Physicians Plus at
(800) 545-5015 within 72 hours after receiving
emergency or urgent care outside of
the Physicians Plus network. All other
care, including follow-up care, should be
obtained from network providers unless
approved by Physicians Plus, as described
above.
Mental and Behavioral Health Services
Contact UW Behavioral Health at (608) 233-
3575 or (800) 683-2300 for prior authorization
Monday through Friday, 8:00 a.m. to 5:00
p.m. For emergencies, please contact your
therapist. If you do not currently have a
therapist, call a Physicians Plus participating
emergency room. A mental health
professional will assess your situation and
refer you to the appropriate provider.
Dental Benefits
No routine dental coverage provided.
Members are now eligible for an additional $50 in wellness incentives after completing their
health assessment. Visit pplusic.com/members/member-materials/state for more information.
Decision Guide Page 47