Covered and Non-Covered Services
You do not have to pay for covered services other than required copayments. The amount of your co-pay cannot be greater than it would have been in fee-for-service. To help ensure that you are not billed for services, you must see a provider in iCare’s network. The only exception is for emergencies. If you are willing to accept financial responsibility and make a written payment plan with your provider, you may ask for noncovered services. Providers may bill you up to their usual and customary charges for noncovered services. If you get a bill for a service you did not agree to, or believe that you should not have been billed, please call 1-800-777-4376.
Co-Payments
iCare and its providers and subcontractors may bill you for small service and/or prescription drug fees, called co-payments. The following members do not have to pay co-payments:
- iCare Medicaid SSI members
- Nursing home residents
- Pregnant women
- Members under 19 years of age who are members of a federally recognized tribe
- Members under 19 years of age with incomes at or below 100 percent of the Federal Poverty Level (FPL)
- iCare Family Care Partnership members
With your plan, you do not have to pay for covered services other than required copayments. The amount of your co-pay cannot be greater than it would have been in fee-for-service. To help ensure that you are not billed for services, you must see a provider in iCare’s network. The only exception is for emergencies. If you are willing to accept financial responsibility and make a written payment plan with your provider, you may ask for noncovered services. Providers may bill you up to their usual and customary charges for noncovered services. If you get a bill for a service you did not agree to, or believe that you should not have been billed, please call 1-800-777-4376.
Medical Services Received Outside Wisconsin
If you travel outside Wisconsin and need emergency care, health care providers in the area where you travel can treat you and send the bill to iCare. You may have copayments for emergency services provided outside Wisconsin.
iCare does not cover any services, including emergency services, provided outside the United States, Canada, and Mexico. If you need emergency services while in Canada or Mexico, iCare will cover the service only if the doctor’s or hospital’s bank is in the United States. Other services may be covered with HMO approval if the provider has a U.S. bank. Please call iCare if you get any emergency services outside the United States.
If you get a bill for services, call our Customer Service Department at 1-800-777-4376 right away.
Other Insurance
If you have other insurance in addition to iCare, you must tell your doctor or other provider. Your health care provider must bill your other insurance before billing iCare. If your iCare network doctor does not accept your other insurance, call the HMO Enrollment Specialist at 1-800-291-2002. The Enrollment Specialist can tell you how to match your HMO enrollment with your other insurance so you can use both insurance plans.
