Insurance, Billing and Payments

Insurance, Billing and Payments

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Billing and Financial Navigation

Billing and Payments
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Good Faith Estimate
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Understanding Your Health Insurance Coverage

What your insurance covers — and what you have to pay — depends on the plan you have. Health insurance plans can be very different from one another.

What you pay is based on your plan’s:

  • Copay: A set fee for a visit or service
  • Coinsurance: A percent of the cost you must pay
  • Deductible: The amount you pay before insurance starts to help
  • Out-of-pocket maximum: The most you have to pay in a year

Some insurance plans consider Children’s Wisconsin out-of-network, which means:

  • You may have to pay more out of your own pocket
  • In some cases, your insurance won’t pay at all for services here

Review what your plan covers when choosing a health insurance plan.

Ask the Right Questions About Your Insurance

Before your visit, it’s important to find out if Children’s Wisconsin is covered by your health insurance plan. But that’s just the first step.

You should also understand your coverage — what services your plan will pay for and how much you’ll owe.

To do this:

  • Read your plan’s benefits
  • Call your insurance company with questions

Need a Cost Estimate?

Our Financial Counseling team can help.

Available 8 a.m. - 5 p.m., Monday through Friday.

At Every Visit, We’ll Ask You To Check Your Insurance Information.

Be ready to show your insurance card, and tell us if any of the following have changed:

  • Address
  • Phone number
  • Employer
  • Insurance

What to Know About Payments at Your Appointment

When you come to your appointment, you may be asked to pay for:

  • Co-payments required by your insurance
  • Services not covered by your insurance (some clinics may ask you to set up a payment plan)
  • A deposit, if you don’t have insurance

We accept checks, credit cards and debit cards.

Please note: We do not accept cash.

You’re Protected From Surprise Bills

If you get emergency care or see an out-of-network provider at an in-network hospital or surgery center, you are protected from balance billing (extra charges from doctors or hospitals). Learn More

No Insurance or Not Using It?

You can ask for a price estimate for your care before your visit. Learn More

Is Children’s Wisconsin Covered by Your Insurance Plan?

When you choose a health insurance plan — especially during open enrollment — it’s important to check if Children’s Wisconsin is included in the plans available to you.

Even if you keep the same plan each year, your covered doctors or hospitals could still change. Always double-check your plan.

What to Know

  • Check your open enrollment materials or call your insurance company to see if Children’s Wisconsin is in-network.
  • Be sure you also understand your level of coverage — what’s included and what you may have to pay.

Specialty Care

Doctors and nurse practitioners in our specialty clinics work for the Medical College of Wisconsin, which is a separate organization. They may not be included in the same plans or covered the same way as Children’s Wisconsin.

Always confirm with your insurance company.

Dental, Behavioral Health and Transplants:

  • Some plans cover dental or behavioral health services at Children’s Wisconsin.
  • Transplant services are usually handled through special networks. Check with your insurance company about these types of care.

If your insurance company is not listed on our website, call them directly to ask if Children’s Wisconsin is covered.

Reminder: The list of accepted insurance plans is updated every year. It may not show your plan’s current or future coverage. Always check with your insurance company for the most accurate information.

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

  • Aetna*
  • The Alliance Employer Health Care Cooperative
  • America's PPO
  • Anthem Wisconsin*
  • Aspirus Health Plan

C

  • Centivo
  • Chorus Community Health Plans
  • Cigna Health Plan
  • CareSource (Formerly known as Common Ground)

F

  • First Health Network by Coventry

H

  • Health Partners
  • Health Payment Systems
  • HealthEOS

I

  • iCare Wisconsin

M

  • Managed Health Services (MHS)
  • Medicaid Wisconsin
  • Medicare
  • Molina Healthcare
  • Multiplan (wrap network only)

N

  • Network Health Plan*

O

  • OAN EverPointe Elite

P

  • Private Health Care Systems (PHCS)

S

  • Sheboygan Employer's Health Network (SEHN)

T

  • Trilogy Health Networks
  • TriWest

U

  • UnitedHealthcare*
  • USA Managed Care Organization

W

  • Wisconsin Crime Victims Compensation Program
  • WPS Statewide PPO

 

*Excludes Medicare Advantage