Description
The Access Plan by Dean network option is a preferred provider organization (PPO) that provides you access to thousands of preferred providers across Wisconsin and nationwide through the First Health PPO network of providers. This includes the Dean Health Plan HMO providers in southern Wisconsin, making it a great network for anyone who lives out-of-state, travels frequently, or has children away at school. Out-of-network providers are available worldwide.
Provider Directory
The Access Plan and Access High Deductible Health Plan (HDHP) use the First Health provider network throughout Wisconsin and nationwide. In Southern Wisconsin, members also have access to Dean HMO providers. To search for providers, see the instructions below. If you choose to seek care from an out-of-network provider, you will be responsible for paying higher out-of-pocket costs.
To find a provider go to to Dean's Group Health Insurance webpage and under the Providers and information section:
To search for nationwide providers under Online Provider Search, follow the instructions below:
- Under Online provider search: Next to Access PPO Network click "Find a First Health provider."
- Click "Start Now."
- Under Type of provider: select "All providers."
- Under Search by: select "Search by state."
- Select desired state from the State dropdown.
- Select a county name from the County dropdown or a city name from the City dropdown. You can select up to seven counties or cities at a time.
- Click "Search Now."
- Then you can further refine your Search results using the “Refine location” and/or “Refine Your results” tool options to the left.
Before seeking medical care with First Health providers, we suggest confirming your provider's network participation by calling your provider's office and asking if they participate in the First Health Network.
To search for Dean HMO providers in Southern Wisconsin, under Online Provider Search:
- Click on "HMO network."
- Under Select Plan Type, choose “Commercial HMO/POS Insurance (Group or Individual Coverage)."
Referrals, Authorizations, Out-of-Network
Prior authorizations are required for certain procedures or services before you receive care. A prior authorization is a written request that is completed by your Primary Care Provider and/or network specialist provider requesting authorization of a specific service(s) or procedure that is to be performed. Review our prior authorization list for examples of procedures and services requiring prior authorization. This is not a complete list. Contact Member Services at 1-800-279-1301 to verify whether a procedure or service needs prior authorization.
If your health care provider recommends a service or procedure that needs prior authorization, they should submit a prior authorization request form to us. It’s your responsibility to make sure your provider requests prior authorization at least 15 business days before the date of your service or procedure. We’ll notify you in writing of our decision.
If you receive services without an approved prior authorization request, the claim may be paid at the out-of-network benefit or denied if it’s found ineligible for coverage.
Out-of-Network Care
You can choose to seek care from health care providers that are not in our network. However, if you get care from an out-of-network provider you’ll be responsible for paying higher out-of-pocket costs. Deductibles and out-of-pocket limits vary between plan design options. Refer to your schedule of benefits for complete details.
If you see an out-of-network provider, we’ll pay charges up to our maximum allowable fee. If there’s a difference between the maximum allowable fee and the amount billed by your out-of-network provider, we’ll review the appropriateness of fees that exceed the maximum allowable fee, holding you harmless. Please call Member Services if you have questions about the maximum allowable fee.
If an in-network provider cannot provide care that you need, we may cover care you receive from an out-of-network provider as if that provider is in-network with an approved prior authorization.
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.
No prior authorization is needed for emergency and urgent care. However, you should notify us as soon as possible if you are admitted as an inpatient.
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 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.
Schedule of Benefits
Review your Schedule of Benefits for an explanation of what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services. See your Certificate of Coverage for complete coverage details.
Major Health Systems
Search for a provider on First Health’s Locate a Provider webpage.