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Changes to PPIC Coverage: UW Health FAQ for Patients and Families

Guaranteed Access to UW Health: Unity

As always, the best way to ensure that you will have unrestricted access to UW Health doctors and services is to select Unity Health Plans, if possible, or, if Unity is not an option for you, another health plan that offers access to UW Health. Learn more at: unityanduwhealth.com

 

Questions?

Please contact a patient resources representative at (608) 821-4819

 

More Information

View this page as a pdf

What is UW Health? (pdf)

Introduction and Overview

 

In June 2012, Physicians Plus Insurance Corporation (PPIC) announced coverage restrictions that will begin January 1, 2013, limiting the access of PPIC members to health care services offered at UW Health locations owned and operated by UW Hospital and Clinics (UWHC).

 

To minimize confusion and disruption of longstanding doctor-patient relationships, we want to do everything we can to answer your questions. Whenever possible we want to help you keep your doctor and if that’s not possible, to assist you in transitioning your care within UW Health.

 

Starting January 1, the PPIC changes have three major impacts:

  1. Primary care: PPIC will no longer cover the cost of care by primary care doctors who practice at UWHC-owned and operated locations (see Question 1).
  2. Specialty care: For most specialties, PPIC will no longer cover the cost of care by specialty doctors who practice at UWHC-owned and operated locations (see Question 8) unless the visit is authorized in advance by PPIC. For a limited number of specialties for which PPIC does not require prior authorization of clinic visits at UWHC-owned and operated locations, see Question 8 or Question 16.
  3. PPIC will no longer cover the cost of tests such as blood tests and X-rays at UWHC-owned and operated locations, unless the tests are authorized in advance by PPIC. For a limited number of specialties for which PPIC does not require prior authorization of laboratory or X-ray services that are part of a clinic visit at UWHC-owned and operated locations, see Question 8 or Question 16.

NOTE: If you are an employee of Dane County or Verona School District, PPIC has indicated these restrictions do not apply to you at this time. You may wish to contact PPIC to confirm this information.

 

To help clarify which UW Health locations are affected by the PPIC restrictions:

  • View a list (pdf) of
    1. UW Hospital and Clinics locations
    2. UW Medical Foundation and UW Department of Family Medicine locations
    3. Specialties that do not require prior approval for care at UWHC locations

For additional questions and concerns, please don’t hesitate to contact the UW Health Welcome Center at (608) 821-4819 or 800-552-4255.