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.
How to find a provider 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 “Select a plan” and then click “The Alliance for UW Student Health Insurance Plan (SHIP)”
- For a provider outside of Madison, enter the location where you want care next to “Your Location”
- Type “Pediatrics” in the search box
If your doctor recommended you to have a CT or MRI scan, click here for details on how to 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).
- 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 800-223-4139. After the Spanish prompt, press 3, then 2, then 2, then 1, and then 1.
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, click here.
If you are having difficulty using the Online Provider Directory, a customer service representative from First Health can help you. Call 800-226-5116. After the initial message press 2, then 1, and then 1.