Tier 1 – University Health Services (UHS)
Unless you have a medical emergency, you (and any covered spouse or partner) must use UHS for all available primary, urgent and preventive care during business hours. This requirement does not apply to covered dependent children, since UHS does not provide pediatric care. Other exceptions are listed in the “Waiver of Primary Care Provider Requirements” section in the online Plan Document.
Most UHS services are fully covered for SHIP members with no out-of-pocket expense.
Covered visits to In-Network providers are subject to applicable Deductible, Coinsurance, or Copayment responsibilities as detailed in the online Plan Document. Please remember that benefits are payable in accordance with the Plan Document. For specific plan benefits questions, call the SHIP Claims Administrator, Wellfleet, at 1-877-657-5031.
333 East Campus Mall, 5th & 6th Floors Primary Care; Gynecology; Sexual Health (STI testing and treatment); Allergy/Immunization.
333 East Campus Mall, 7th Floor
24/7 Crisis Services
Individual, group, and couple/partner counseling
Utilizing Network providers for services not available at UHS
UHS is not open evenings and weekends and does not provide Emergency Room care, hospitalization, or specialty care for complex problems. In these instances, SHIP members have access to providers through our local and nationwide Networks. Please note that a referral is not necessary for services not offered at UHS.
Covered visits to Network providers are subject to applicable Deductible, Coinsurance, or Copayment cost-sharing responsibilities as detailed in the online Plan Document.
Tier 2 – The Alliance Premier Ruby Network (Wisconsin)
Your member cost-sharing is lower when you use the high-value providers in The Alliance Premier Ruby Network for eligible services. Madison area Premier Ruby Network providers include all UW Health Clinics and Hospitals, and UnityPoint Health-Meriter Hospital and Clinics.
Tier 3 – The Alliance Comprehensive Network (Wisconsin)
SHIP members have the flexibility to utilize providers in the rest of The Alliance Comprehensive Network. Standard member cost-sharing is higher than the Premier Ruby Network.
Finding a provider in The Alliance Premier Ruby Network (Tier 2) or The Alliance Comprehensive Network (Tier 3)
Providers in both the Premier Ruby Network (Tier 2) and the Comprehensive Network (Tier 3) are conveniently listed on The Alliance search page. Simply follow the instructions below to locate a provider. When you review the search results, the Tier of coverage will be listed for each provider (Tier 2 or Tier 3). This is how you determine if a provider is in the Premier Ruby Network (Tier 2) or the Comprehensive Network (Tier 3).
Find a provider in The Alliance Premier Ruby Network or The Alliance Comprehensive Network.
For example, to search for a list of pediatric providers:
- Click “Choose a location” and enter your address or city (for example, Madison, WI).
- Click “Yes, this is correct”.
- Click “Doctors by specialty” and type “Pediatrics” in the search box.
Note – you can also change the default location to view providers in a different part of The Alliance service area.
Notes on The Alliance provider search results:
- Some locations charge a separate Facility Fee. This will be detailed on the provider listing under “Important Notes”. Although, SHIP does pay for Facility Fees, your final member cost may be higher if you choose one of those locations (since any member cost-sharing would also apply to the Facility Fee).
- Some individual providers may only be considered in a Network at the location listed under their profile in the search results.
- You can adjust the filters of your search, such as: Distance; Specialty; Accepting New Patients.
If you are having difficulty using the Online Provider Directory, a customer service representative from The Alliance can help you. For assistance, call 1-608-276-6630. After the Spanish prompt, press 2, then 1, and then 1 again.
You can also call The Alliance customer service for a procedure cost estimate. Choose one Network provider or choose more to compare cost estimates.
Additional Benefit – no member cost for MRI and CAT scans when provided by select Imaging Providers
Through a special arrangement with The Alliance, there is no cost for members when select Imaging Providers are utilized for covered services including MRI and CAT scans. Madison providers include MH Imaging and Smart Scan Medical Imaging. Please note that these select Imaging Providers will be listed as Tier 3 in the search results, but to confirm – there is no member cost sharing for covered services at these providers. Contact The Alliance customer service for assistance in locating an Imaging Provider.
Tier 3 – First Health Network (outside Wisconsin)
The First Health Network gives SHIP members access to providers nationwide when outside The Alliance service area. Standard member cost-sharing is higher than The Alliance Premier Ruby Network.
First Health provides Network coverage when you are unable to find a provider in either The Alliance Premier Ruby Network or The Alliance Comprehensive Network. First Health is a national network, with providers throughout the United States. To locate a provider in the First Health network, select “First Health network” under “Network Options” on the Online Provider Directory page.
If you are unable to locate a provider in the Online Provider Directory, please call First Health Customer Service at: 1-800-226-5116 and press 1 to speak with a team member. Hours of operation are 7am to 7pm (CST), Monday – Friday.
Tier 4 – Out-of-Network
“Out-of-Network” refers to a provider which has no special agreement with SHIP. Because there is no agreement, treatment costs and your Deductible and Coinsurance responsibilities are higher.
Emergency Room and Urgent Care in Madison
Urgent care during evenings and weekends
Examples of urgent care conditions include:
Rashes; colds/flu; sore throats; minor cuts; earaches; headaches; abrasions; back pain; sprains; minor fractures.
If UHS is closed, use an urgent care center when available. These centers provide care for acute problems that are not life-threatening.
Network Urgent care centers in Madison
(Life-threatening medical emergencies)
Examples of medical emergencies include:
Alcohol or drug intoxication/overdose; large or deep cuts; bleeding; bicycle or motor vehicle accidents; major fractures (bone through skin); face or eye injury; loss of consciousness; seizures/convulsions; shortness of breath; chest pain; severe abdominal pain.
If you have a life-threatening medical emergency, dial 911 or go to the nearest hospital ER.
Emergency Rooms in Madison