Description
Prevea360 Health Plan is brought to you by Wisconsin-based Dean Health Plan by Medica. While the way many insurance companies and physicians measure success has led to a healthcare system that focuses more on illness than wellness, we want to transform healthcare to shift the focus from illness to wellness. We aim to ensure convenient and accessible care options that cater to your specific needs. We’re a health plan that’s a part of your community and strives to meet you where you are. Our integrated approach focuses on the doctor-patient relationship. That means health providers, a pharmacy benefits manager, and a health plan all collaborating on a single plan revolving around your health and wellness.
What's Included
Advance care planning is the process of thinking about, communicating, and documenting your future health care wishes in case of illness, accident, or sudden medical event.
We want to ensure that your health care wishes are known and respected. Social workers are available to help any member over age 18 begin or continue the process of advance care planning. Find out more on our Care Management webpage.
Provider Directory
Find providers on the Providers and Information section of our State of Wisconsin Group Health Insurance Program webpage and select “Online Provider Search” or “State of WI – Prevea360 East” (PDF). To request a printed directory by mail, call 1-877-230-7555.
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 of 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 may check the status of your request at MyPrevea. If you’re unsure if a service, test, or procedure requires prior authorization or a referral, call 1-877-230-7555 prior to the 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 1-877-230-7555, if possible, when you receive emergency care. If assistance is needed to determine the appropriate level of care outside of normal working hours, contact Prevea Care After Hours at 1-888-277-3832. Follow-up care must be received by an in-network provider unless otherwise approved by Prevea360.
- On My Way allows you to make a reservation at the Prevea Urgent Care of your choice from the comfort of your home. You choose one of the available times and have the option of receiving a text message reminder.
- Online scheduling makes primary care clinic appointments a snap. Simply visit the Prevea health website. Then click "Schedule Online" and follow the prompts to select a time with your doctor.
Most often primary care providers (PCPs) should be your first choice for care both because they are familiar with your medical history and because 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
Prevea Care After Hours is a free telephone service for Prevea360 Health Plan members. It's available 24 hours a day, 365 days a year. If you're not sure you need to see a doctor—or wondering if you have a problem—give us a call. Call 1-888-277-3832 or 1-920-496-4700 anytime to speak with a registered nurse.
Experienced registered nurses at Prevea Care After Hours are always available to answer your questions and concerns. When responding to your call, they draw on years of clinical experience in many medical specialties.
Learn more about Prevea Care After Hours.
Virtual Visits
E-visit - the lowest-cost option
You can get care from the comfort of your own home. In 60 minutes or less during regular business hours, you can reach a trusted provider when you need them most. You’ll get a diagnosis, treatment plan, and any needed prescriptions. Virtual care is available to members through age 75. To ensure members receive the highest quality of care, those age 76 and above should be seen at a clinic or doctor's office. Try virtual care for:
- Coronavirus (COVID-19)
- Upper respiratory infections
- Urinary tract infections
- Lice
- Yeast infections
- Pink eye/conjunctivitis
- Acid reflux/GERD
- And more
Find the conditions commonly treated in an e-visit and get help to find the right care anytime online.
Major Health Systems
- Prevea Health Clinics
- HSHS Health System WI Hospitals and Clinics
- Door County Memorial Hospital & Medical Center
- Holy Family Memorial Hospital and Clinics