How much will I pay for services referred by WHF Medical
Clinic to a physician or hospital outside of the clinic?
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 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?
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?
uses tthree medical PPO networks for our members – United
Healthcare (UHC) , HealthEOS/WPPN and Trilogy health
network. 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 . For members enrolled in
the Trilogy health network, you may access provider
information by calliing 1-866-748-8659 or going on their
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?
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
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
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
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
How do I switch plans to use
the WHF Medical Clinic if I currently am seeing a physician
outside of the clinic?
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
How much will it cost me to
have a colonoscopy?
While WHF can
inform you of the benefits available under your plan, any
costs you may be responsible for will be determined based on
the following: diagnostic code provided, whether the
provider was in-network or out-of-network, and the type of
individual surgical treatments received.