Description
Dean Health Plan by Medica offers a holistic approach to your well-being. We’ll meet you where you are and give you the benefits and support to help maintain balance in your life. We prioritize prevention and work to enhance your overall wellness. You’ll have access to a strong care network– featuring the providers of SSM Health. When you choose us, you benefit from having your clinical team of physicians, specialists, and pharmacies working for you and with your health plan. It’s a different kind of healthcare model where providers and coverage coordinate to better care for you.
You’re covered with 30 hospitals and many conveniently-located primary care sites in 20 counties throughout southern Wisconsin. Take advantage of one of the largest provider networks in southern Wisconsin with:
- 5,200+ practitioners
- 200+ primary care clinic locations, with many owned by SSM Health Medical Group
- 950+ specialty care clinics
What's New for 2024
Joint venture with Medica
In 2021, we formed a joint venture with Medica, a nonprofit health plan serving nearly 1.5 million people. We have significant similarities in our histories, operations, cultures, and deep community commitment. Our relationship is driven by technology, a shared mission-driven vision, and innovation. Together we have an even greater opportunity to support your health care needs and to further enhance our provider relationships.
Provider Directory
To find providers on the Providers and Information section of the State of Wisconsin Group Health Insurance Program webpage, select “HMO Network” or “Dean Health Plan Commercial HMO” (PDF). To request a printed directory by mail, call 1-800-279-1301.
Referrals, Authorizations, Out-of-Network
Referrals are not needed when receiving care from in-network providers.
Prior authorizations are required for certain services, procedures, and for out-of-network providers before you receive care. A prior authorization is a written request that is completed by a network Primary Care Provider and/or network specialist provider. It requests authorization for a specific service(s) or procedure to be performed by an in-network provider or, in some cases, an out-of-network provider.
Prior authorization is required for care from any out-of-network providers unless it is an emergency or urgent care.
You can check the status of your request at DeanConnect. If you’re unsure if a service, test, or procedure requires prior authorization or a referral, call 1-800-279-1301 before your appointment.
Emergency and Urgent Care
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact Member Services at 1-800-279-1301, if possible, when you receive emergency care from an out-of-network provider. Follow-up care must be received by an in-network provider unless otherwise approved by Dean Health Plan.
Most often Primary Care Providers should be your first choice for care. This is because they’re familiar with your medical history and a scheduled office visit is the most cost-effective method of care.
When a more immediate need arises, you have other options. We can help you find the right care in the right place at the right cost.
Mental, Behavioral Health and Substance Abuse
More ways to access mental health services
If you or someone you know is struggling, you’re not alone. We offer many supports, services, and treatment options within our network.
For members with mental health and substance use disorders, our behavioral health and substance use case management provides an individualized approach. The goal is to help you manage your health and live your best life. Learn more about our behavioral health services.
Telemedicine continues to grow every day and more specialties are finding ways to provide virtual options for patients. Find an in-network provider to get started.
A prior authorization is required for the following mental health and substance use services:
- Detox
- Inpatient
- Residential
- Partial hospitalization/day treatment
- Intensive outpatient
- In-home therapy
24-Hour Nurseline
Nurse Advice Line is there whenever you have a health question. You can connect with an experienced registered nurse online or by calling 1-800-576-8773 (TTY: 711).
The Nurse Advice Line is available after-clinic hours from 5 p.m. - 8 p.m. and 24/7 on weekends and holidays to serve patient triage needs.
NOTE: Due to licensing restrictions Nurse Advice Line's triage services are only available to residents of Wisconsin.
Virtual Visits
E-visits: the lowest-cost option
SSM Express Virtual Care is there when you can’t meet with your regular physician or need after-hours care in the comfort of your home.
E-visits are used for minor medical concerns. By filling out a simple online form an SSM Health provider will respond to your care needs electronically. There’s no need to schedule an appointment and costs can vary by plan.*
Virtual visits connect you with an SSM Health provider through a video conference when you want to talk with a physician about an urgent health need. A conference usually happens in a few minutes during operating hours and cost can vary by plan.*
Learn more about choosing the right care.
*Reference your schedule of benefits for cost-sharing.
Major Health Systems
- SSM Health Hospitals and Clinics (Dean Medical Group, Fond du Lac Regional and Monroe Clinics)
- Prairie Ridge Health Hospital & Clinics
- Fort HealthCare Hospital & Clinics
- Sauk Prairie Healthcare Hospital & Clinics
- Southwest Health Hospital & Clinics