When You May Be Billed
For Services
It is very important to follow the rules when you get
medical care so you are not billed for services. You must
receive your care from DHP providers and hospitals
unless you have our approval to go somewhere else.
The only exception is for severe emergencies.
If you travel outside of Wisconsin and need emergency
services, health care providers can treat you and send
claims to DHP.
You may have copayments for emergency services
provided outside of Wisconsin, but the charges for
Medicaid covered services will be no more than the
charges for services in the network.
DHP does not cover any service, including emergency
services, provided outside of the United States, Canada
and Mexico.
If you need emergency services while in Canada or
Mexico, DHP will cover the service only if the provider
or hospital’s bank is in the United States. Other
services may be covered with HMO approval if the
provider has a United States bank. Please call DHP if
you receive emergency services outside the United
States.
Copayments
Under BadgerCare Plus – providers and subcontractors
may bill you for nominal copayments. The following
members are exempt from copayments:
• 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)
If You Are Billed
Under BadgerCare Plus, if you receive a bill for services,
call our Customer Care Center at
(800) 279-1301. You do not have to pay for covered
services (other than a required copayment) that are
provided by a BadgerCare Plus certified provider
and that DHP is required to provide you unless prior
authorization is denied and you are told there will be a
charge for the service before it is provided.
Generally, charging a member for a non-covered service
is allowed, except for certain non-covered services
or activities related to covered services, liked missed
appointments, telephone calls and translation services.
You may request non-covered services from providers,
and providers may collect payment for non-covered
services from you if you accept responsibility for
payment and make payment arrangements with the
provider. Providers may bill you up to their usual and
customary charges for non-covered services.
Other Insurance
If you have other insurance in addition to DHP, you must
tell your PCP or other provider. Your health care provider
must bill your other insurance before billing Dean
Health Plan. If your DHP provider does not accept your
other insurance, call the HMO Enrollment Specialist at
(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.
deancare.com
BadgerCare Plus Member Handbook
6
