Description
MercyCare has been providing dependable, affordable health care coverage since 1994. We coordinate all aspects of health care to give you the best health benefits possible at the lowest cost. MercyCare's integration with Mercyhealth gives you access to Mercyhealth's five hospitals, over 85 primary and specialty care locations and post acute services (home health and hospice services and medical equipment), pharmacies, and retail services. Our MyChart allows members to access medical record and health insurance information, helping you manage costs 24/7. We look forward to serving you!
What's New for 2023
Opening early 2023, Mercyhealth Hospital and Medical Center Crystal Lake will be home to a hospital with private inpatient and intensive care suites, surgery suites, emergency care, and diagnostic services, as well as primary and specialty doctors. From preventive care and screenings to helping you manage chronic conditions, we will be here for you every step of the way.
Provider Directory
Go to mercycarehealthplans.com to access a provider directory. In the middle of the page, click on the box "Find a doctor/facility." Then in the drop-down box, under select your plan, choose "State and Local ETF (HMO) - W9" and select if you would like to search by practitioner or facility/clinic. Once you are there you can narrow your search if you would like by city, last name, etc. You can also view and print a full directory by clicking here.
Referrals, Authorizations, Out-of-Network
Referrals are not needed when receiving care from in-network providers. Prior authorization is required for certain services, procedures, and for out-of-network providers before you receive care. You will receive written notification upon approval or denial for the prior authorization. If you are unsure if a service, test, or procedure requires prior authorization or a referral, call 1-800-895-2421, option 5, prior to the appointment.
MercyCare Health Plans recognizes UW Health and University of Wisconsin Hospital and Clinics (UWHC) as a preferred referral center when care cannot be provided by an in-network provider. Prior authorization would be required for any services provided by UWHC
Emergency and Urgent Care
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact MercyCare Health Plans at 1-800-895-2421, option 5 within 48 hours of receiving care if possible. Follow-up care must be received from an in-network provider unless otherwise approved by MercyCare Health Plans.
Mental, Behavioral Health and Substance Abuse
No prior authorization or referral is required for outpatient services from an in-network provider. Prior authorization and referral is required for inpatient services and transitional care out-of-network. For other services, contact 1-800-895-2421, option 5.
24-Hour Nurseline
Healthline: 608-758-5770 or 1-888-756-6060
Major Health Systems
- Mercyhealth Hospital and Trauma Center–Janesville, WI
- Mercyhealth Hospital and Medical Center–Walworth, WI
- Mercyhealth Hospital and Medical Center–Harvard, IL
- Javon Bea Hospital’s–Riverside & Rockton, IL
- Fort HealthCare, WI
- Watertown HealthCare, WI