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.
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.
"In-Network" providers for services not available at UHS
SHIP has contracts with two provider networks for “In-Network” coverage – The Alliance and First Health, so that members have access to a nationwide network of providers at a discounted rate. Treatment costs are lower for you when you utilize In-Network providers. Please note that a referral is not necessary for services not offered at UHS.
In contrast, “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.
Local Emergency Room and Urgent Care in The Alliance network
(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.
In-Network Emergency Rooms 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.
In-Network Urgent care centers in Madison
How to find other providers in The Alliance network
The Alliance network service area includes most of Wisconsin (including Madison) and extends into Northern Illinois, Eastern Iowa, Eastern Minnesota, and the Upper Peninsula of Michigan.
Find a provider within this service area. For example, to search for a list of pediatric providers:
- Click “Choose a location and plan” and enter your address.
- Type “SHIP” in the the “Find your plan by employer” search box.
- Select SHIP and “Confirm selection”.
- 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 network service area.
If your doctor recommended you to have a CT or MRI scan, call Margie Czechowicz (Patient Experience Manager) at 1-800-223-4139. Margie will explain how you can receive service with no member cost-sharing through The Alliance QualityPath benefit.
Notes on 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-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 in-network provider or choose more to compare cost estimates.
How to find a provider in the First Health network
First Health provides “In-Network” coverage when you are unable to find a provider in The Alliance network. First Health is a national network, with providers throughout the United States, including Wisconsin. 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.