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Insurance Plans - Wisconsin
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AETNA HEALTH INC
ANTHEM HEALTH PLANS OF KENTUCKY, INC.
COMMUNITY HEALTH PARTNERSHIP, INC.
Where to Get Forms: Call 1-800-842-1814 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-842-1814
Phone # to request Exception: 1-800-842-1814
Fax #: 715-838-2910
E-mail Address: bwildenberg@pharmastar.biz
Updated: May 2006
COMMUNITY LIVING ALLIANCE
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
DEAN HEALTH INSURANCE, INC.
ELDER CARE HEALTH PLAN, INC.
Where to Get Forms: Call 608-245-3016 and ask for form to be sent.
Phone # to request Prior Authorization: 608-245-3016
Phone # to request Exception: 608-245-3016
Fax #: Not Available
E-mail Address: bwildenberg@pharmastar.biz
Updated: May 2006
ELDER HEALTH MARYLAND HMO, INC.
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
GUNDERSEN LUTHERAN HEALTH PLAN
Where to Get Forms: Call 1-877-665-6609 and ask to have form sent.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com
Updated: May 2006
HUMANA HEALTH PLAN, INC.
MARQUETTE NATIONAL LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEDICA
Where to Get Forms: Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com
Updated: May 2006
MEMBERHEALTH, INC.
NETWORK HEALTH INSURANCE CORPORATION
Where to Get Forms: Call 1-877-665-6609 and ask to have form sent.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com
Updated: May 2006
PACIFICARE LIFE AND HEALTH INSURANCE COMPANY
PENNSYLVANIA LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
SECURITY HEALTH PLAN OF WISCONSIN, INC
SILVERSCRIPT INSURANCE COMPANY
STERLING LIFE INSURANCE COMPANY
Where to Get Forms: http://www.foxrxcare.com/exceptions.htm
Phone # to request Prior Authorization: 1-888-369-7979
Phone # to request Exception: 1-888-369-7979
Fax #: 1-866-284-4509
E-mail Address: Not Available
Updated: May 2006
UNICARE
UNITED AMERICAN INSURANCE COMPANY
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
UNITED HEALTHCARE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6662 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6662
Phone # to request Exception: 1-800-207-2621
Fax #: 1-866-617-6738
E-mail Address: provider.relations@walgreens.com
Updated: May 2006
WELLCARE HEALTH PLANS
WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
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