FAQ's

How much will I pay for services referred by WHF Medical Clinic to a physician or hospital outside of the clinic?

Most benefits outside of WHF are subject to your annual deductible, and a co-insurance of 10 to 40 percent depending on your plan.  However, some diagnostic procedures (MRI, CAT Scan) may be available at your clinic co-payment for services that can be provided under contracts WHF has arranged with specific diagnostic providers.      

Why am I receiving a bill from United Healthcare? 

When United Healthcare receives and processes claims, an Explanation of Benefits (EOB) is issued to the member and the provider of services. This is not a bill. This statement provides information on how benefits were determined, and indicates the patient liability. You should compare the patient liability on the EOB with the amount billed by the provider of services to verify the amounts are the same.  

Do I need to notify WHF after going to the Emergency Room?

If you use the WHF Medical Center notification is not a requirement of the plan for services provided outside of the clinic.  Your benefits for this service are subject to your medical plan deductible and co-insurance.  It is important for you to schedule any follow up treatment with your WHF physician to reduce your costs, and to provide your WHF physician with information for your medical chart.   

How do I find out if a MD or Hospital is participating in the plan network? 

WHF uses two medical PPO networks for our members – United Healthcare (UHC) and HealthEOS/WPPN. For members enrolled in the UHC network, you may locate provider information by calling 1-866-230-8323 or on the UHC website at myuhc.com. For members enrolled in HealthEOS/WPPN network you may access provider information by calling 1-800-279-9776 or on their website at HealthEOS.com  

Why didn’t my physician at WHF Medical Clinic explain how my benefits would pay before I was referred for services outside of the clinic? 

The physicians at Wisconsin Health Fund Medical Clinic are here to provide medical care to patients using the clinic.  The physicians primary concern is for the appropriate patient treatment. The physicians do not have access to individual patient benefits either under WHF plans or outside carrier plans. If you have questions regarding your medical benefits contact the member services number on your medical card.

What should I do in a medical emergency? 

If you have a life-threatening medical emergency, you should obtain care at the nearest facility equipped to treat you. Examples of emergency medical situations may include a heart attack, severe lacerations or uncontrollable bleeding, loss of consciousness, stroke or poisoning. While you are not penalized in emergency situations if a non-network provider is used, in order to maximize your benefits and reduce out of pocket costs make sure to schedule any follow up treatment with your WHF Medical Center physician or another in-network plan provider.

Who do I contact for questions regarding bills I received for services provided at the WHF Medical Clinic? 

For answers to questions regarding account balances or bills for services done at the WHF Clinic call (414) 771-5600 and ask for the medical billing department.

How do I get reimbursed if a prescription needs to be purchased when the WHF Pharmacy is closed? 

If you need an emergency prescription for a pain medication or antibiotic and cannot use a Fund-approved pharmacy, the Plan will pay for up to a ten (10) day supply filled at any pharmacy. You will have to pay for the prescription at the pharmacy and submit the RX receipt thru Serve You for reimbursement. 

How do I switch plans to use the WHF Medical Clinic if I currently am seeing a physician outside of the clinic? 

In the past WHF members were offered two plans – to have treatment done through the WHF Clinic or treatment done outside of the clinic. The plans were combined, and you are no longer required to select a plan. You and each family member can choose when and how you want to use the Medical Center. The level of benefits is determined based on where you go for treatment. If you use the WHF Clinic you are responsible for a single co-payment per visit. If you elect to go outside the WHF Clinic your benefits are based on if you use an in-network or out-of-network provider, and are subject to your annual deductible, co-insurance and out of pocket maximums.

How much will it cost me to have a colonoscopy? 

Wisconsin Health Fund does not know the fees charged for procedures done outside of our medical clinic. While WHF can inform you of the benefits available under your plan, the provider of services establishes the actual fees charged.  The fees charged may not be the same for each patient, because individual surgical treatments may vary between patients. In addition the benefits may be based on contractual discounts arranged through outside network contracts, or reduced by usual and customary allowances. A Treatment Cost Estimator is available to members enrolled in the United Healthcare PPO Network on their website located at myuhc.com.