Insurance Info

We contract with a variety of insurance carriers; including but not limited to:

  • Aetna
  • Anthem BCBS
  • Arise
  • Champ VA
  • Cigna
  • Common Ground
  • HealthPartners
  • HealthScope
  • Humana
  • Lucent
  • Medicaid (BCBS Medicaid, Molina Medicaid, Security Medicaid, Trilogy Medicaid, UHC Medicaid)
  • Medicare
  • Network Health
  • Network – Prestige NE
  • Quartz
  • UHC
  • UMR
  • WPS
  • Tricare

We always encourage patients to contact their insurance carrier directly to verify if services will be covered at our office. In addition, we will work with you to help you understand your coverage and benefits, as well as arrange convenient payment plans for any out-of-pocket expenses. We have a full time billing staff on site, including a financial counselor. If you have questions and concerns about your bill, we can help you to know what to ask your insurance carrier in order to get your bills processed.

We work with some third party administrators and self-funded plans. We are in-network providers for Health EOS and Health EOS/Multiplan. If your insurance carrier uses their services to process your claims and you have questions, please contact our business office.

If you do not have medical coverage or have no maternity benefits through your health care plan, call our financial counselor at (920) 749-4000.

If you are a human resources manager and have questions on benefits and services, please call us at (920) 749-4000.

Network Health*Women’s Health Specialists is a participating provider of Network Health. We are the only privately owned OB/GYN specialist who can accept Network Health in Appleton and Neenah, and at any Women’s Health Specialists service site in the greater Fox Cities. Network Health members are encouraged to call our financial counselor at (920) 749-4000 to determine in-plan provider coverage.

Serving patients at ThedaCare Regional Medical Center - Appleton, ThedaCare Regional Medical Center - Neenah, Encircle Health – Appleton, and at Ascension - St. Elizabeth Hospital.

Wisconsin Medicaid / BadgerCare Plus
If you have Wisconsin Medicaid / BadgerCare Plus , please note Women’s Health Specialists is ONLY a provider for certain Medicaid HMO products. These include:

  • BCBS Medicaid
  • Molina Medicaid
  • Security Medicaid
  • Trilogy Medicaid
  • UHC Medicaid

If you have an HMO that we are not in-network with, you can choose another HMO in order to be covered at Women’s Health Specialists. To change your HMO, you can call the Medicaid HMO enrollment specialist at ((800) 291-2002. In order to be seen, your Medicaid coverage must be verified as active prior to all appointments.

Frequently Asked Questions

I am covered under two or more different insurances, what are the rules over who is Primary payor vs. secondary payor?
  1. If you are covered by an insurance that the subscriber is yourself, this policy will always be primary.
  2. If you are covered under two different parent policy where you are a dependent, most insurance companies follow the date of birth rule.  Primary payor would be whose ever date of birth comes first in the calendar year.  Example: UHC under Mother whose date of birth is 1/15/1984 would be primary over Anthem policy under Father whose date of birth is 3/15/1983.  UHC would be primary and Anthem would act as secondary payor.  Keeping in mind both insurance companies need to be informed about all other policies you are covered under.
  3. If you are covered under a parent policy and spouse policy, most insurance companies follow the rule, whichever policy you were on the longest will act as primary. Normally this would be the parent policy.  Please call both insurance companies so they know about any other coverage you may have.
  4. If you have a Commercial Policy and Medical Assistance (Forward Health) for coverages, Medical Assistance will always be the payor of last resort. Medical Assistance picks up any balances after all commercial Policy have been billed. 
  5. These are the normal guidelines we follow, but it is best to discuss this with your insurance company as they are the ones who will make the final determination on who will act as primary and who will be secondary.
I Qualify for Medical Assistance so can I just use that as my only insurance?
  1. If Medical Assistance is your only coverage, then yes. If you are covered under a commercial policy, under yourself, parent or spouse this coverage would be billed before Medical Assistance.  Should you fail to give us all active coverages you may see denials by your Medicaid coverage for other primary insurance.
  2. If you decide to terminate your commercial policy, you must notify Medical Assistance so they can process your claims as primary payor. If Medical Assistance has another payor on file in their system they will deny claims asking us to submit to commercial policy first.
How does State insurance or medical assistance work with other coverages?

You must notify Medical Assistance if you are covered under a commercial policy and they will act as secondary payor picking up any deductibles, coinsurance, and copays owed.

What if I am not sure what insurance coverage I have?
  1. You would need to see if you have coverage under your work, and call your Human Resources department for help.
  2. Most parents policy can keep children on their policy until they turn 26 years old, so please talk to your parents to see if you are still covered under their plan.
  3. If you are married you may be covered under your spouse’s policy through his work, he can call his Human Resource department for help.
  4. If you have no coverage, consider applying for Medical Assistance through the state of Wisconsin to see if you qualify.  Or enroll in a Marketplace policy.
What if I do not have any insurance coverage, can I be seen for an appointment?

We offer a 20% discount on charges for self-pay patients to be paid up front at the time of the appointment. Please call our office to be given a self-pay estimate for services you want done.

I have insurance so why am I receiving a bill?
  1. Most insurance companies have deductibles, Coinsurance, and Copays associated with your plan. Every plan is different so make sure you call your insurance company to understand your benefits. 
  2. Deductible is a specified amount of money that the insured must pay before an insurance company will start paying towards balances.
  3. Once the deductible is met some policies also have Coinsurance which is the insured pays a share of the payment with the insurance company. For example, Insurance will pay 80% and the insured will pay 20% of the allowed charges. 
  4. Every policy has an Out-Of-Pocket max, once this is reached Insurance will start to pay 100% of allowed charges.
I was seen at Women’s Health for lab, so why am I getting a bill from Thedacare?

Most insurance companies do not allow pass-through billing. This means insurance companies want to be billed for the lab by those who are processing the lab.  Women’s Health Specialists only draw your blood in the office, and then we send specimens to Thedacare for processing in the lab and getting results.  Insurance companies like Anthem and UHC will only allow us to bill the fee for drawing your blood.

I am currently pregnant and my insurance will be switching during pregnancy. How does that work in regards to billing?

The Delivery Billing code includes 13 Obstetrical checkups, Delivery of the baby, and your 6-week postpartum visit. This is all billed at the time you deliver your baby.  Any lab work and Ultrasounds done will be billed separately and at the time of your visit.  Should you switch insurances due to changing jobs or going on someone else’s policy, like a spouse, we will need to break down the Delivery care.  Meaning we add up the number of visits with each insurance and bill them to the proper insurance.  For example, the patient started out with Anthem and saw a Doctor for 6 visits before switching to UHC.  She had 7 visits with UHC before delivering a baby.  We would bill 6 visits to Anthem, 7 visits to UHC, and bill Delivery and postpartum only to UHC as well.  

My claims are denying for Coordination of Benefits update needed from my insurance, what is that and how do I fix this issue?

Most insurance companies request Coordination of Benefits updates annually from their members. They will deny claims until the member calls their insurance to update whether they have other coverage under another insurance policy.  This can be updated with the insurance company either by calling them, updating it on their website if they have one, or filling out and mailing back the form you should have gotten in the mail.

How do I find out what my insurance will cover at my appointment?

Every insurance policy is different unfortunately and the best way to be sure of coverage is to call your insurance company with the CPT codes of the services you are going to have done at your visit. Please give our office a call if you would like the procedure codes to call your insurance.

I just got a new insurance policy, but I have not gotten my new insurance cards with my insurance information. Can I still schedule an appointment?

Our office policy is to verify and load insurance policies before scheduling an appointment. If we do not have an insurance loaded the appointment will be treated as self-pay.  A self-pay estimate will be given and payment is due at your appointment.  If you schedule an appointment as self-pay initially and get coverage added to your visit before your appointment, you will not need to pay the self-pay estimate and insurance will be billed.   If you paid the self-pay estimate at your appointment and then got coverage after, please call our office and speak to the billing department.  We will send a claim to your insurance and refund any money overpaid after the insurance processes your claim.

I have a balance, why am I not getting a bill in the mail?
  1. As of 1/1/2022 ThedaCare has switched over all patients with a MyThedacare account to paperless billing. Since Women’s Health Specialists uses this feature offered by ThedaCare, this has affected our billing statements as will.  With paperless billing, you will only be receiving an emailed billing statement, under the email associated with our MyThedacare account. 
  2. If you are not on paperless billing, and still are not receiving statements in the mail, please call our office and speak to our Billing Department for assistance.
How do I turn off paperless billing?

Login to your MyThedacare account and click the Menu button. Under the Billing Section click “Billing Summary”.  Scroll to the bottom of the screen to find: “If you would like to receive paper statements, you may cancel paperless billing.”  Click on Cancel Paperless Billing. 

I have a balance that I can’t pay in full. How do I set up a payment plan?
  1. Payment plans can be set up by logging into your MyThedacare Account if you have one, and go to the billing section to see your balances and payment options. There is also an option for auto payments that will be taken automatically on a specific day of the month.
  2. Or you can call our office and speak to the billing department to set up a payment plan on your account for you.
  3. Office policy is to have payment plans paid off within a year from the date services were rendered.
How do I pay on a balance that was sent to collections?

Women’s Health Specialists use the Finance Systems of Green Bay as their collection agency. You can either call them directly or call our billing department to assist you.  Please note all collection balances need to be paid in full before any future appointments can be made in our clinic.