Description

What’s New for 2019

Group Health Cooperative of Eau Claire is pleased to serve counties throughout Northern and Central Wisconsin.

Members of the Cooperative now have access to our care management app, Valera Health. Using Valera’s virtual chat function, Group Health Cooperative’s case management team has the ability to conveniently connect with members to provide support and self-help resources. The chat feature helps individuals manage behavioral health conditions like depression and anxiety as well as medical conditions such as asthma, diabetes and heart failure. Members have the opportunity to set goals, make connections to appropriate services and improve overall wellbeing. To learn more about the program, call 1-888-203-7770 to speak with Member Services.

Provider Directory

Go to group-health.com to access a provider directory. Use www.group-health.com/Directories/Providers.aspx as a direct path or visit www.group-health.com, choose “Members,” then “My Plan” and State of WI Group Health Insurance Program. To request a printed directory be mailed to you, call Member Services at 1-888-203-7770.

Referrals, Authorizations, Out-of-Network

Referrals are not needed when receiving care from in-network providers. You must get a prior authorization before receiving care from an out-of-network provider, for all admissions and for select outpatient services. You will receive written notification of the approval or denial for the prior authorization. Members with low back pain are required to participate in a shared decision making tool to review information on options, outcomes and to clarify personal values. For further information regarding authorization guidelines, please visit group-health.com or call 1-888-203-7770 to speak with Member Services.

Emergency and Urgent Care

If you require emergency or urgent care while outside the network, seek care at the nearest medical facility. Use the FirstCare Nurseline listed on your ID card if assistance is needed to determine the appropriate level of care. Follow-up care must be received from an in-network provider unless otherwise authorized by the Cooperative.

Mental, Behavioral Health and Substance Abuse

No referral is needed to see a provider in the Cooperative’s network. Prior authorization guidelines may apply for certain services; please contact Member Services at 1-888-203-7770 for additional information. Please refer to the provider directory for a listing of mental health providers in the Cooperative’s network.

24-Hour Nurseline

FirstCare Nurseline: 1-800-586-5473

Major Health Systems

  • Ascension / Ministry Medical Group
  • Aspirus
  • Essentia Health
  • Marshfield Clinic
  • St. Lukes Health Care System / St. Lukes

Full Service Areas

Ashland County, Bayfield County, Burnett County, Clark County, Douglas County, Iron County, Langlade County, Lincoln County, Marathon County, Oneida County, Price County, Sawyer County, Taylor County, Vilas County, Washburn County

Limited Service Areas

Minnesota, Michigan
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