Tools To Make The Most Of Your Health Plan


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Specialty Care

HMO Members
State of Wisconsin Participants
Local Government Participants
Unity does not require HMO members or State of Wisconsin and Local Government participants to obtain a referral from a PCP before accessing in-network specialty care.

Requests for out-of-network referrals will be reviewed only for services that are not available from our participating providers. Your PCP must submit a Prior Authorization Request Form  if you seek out-of-network care. Services are subject to:

If Unity approves a request for out-of-network care, services are covered up to the usual, customary and reasonable charge. For a description of your covered benefits, login to MyUnity and refer to your Schedule of Benefits and Certificate of Coverage. State and local government participants should refer to the It's Your Choice book.

POS and PPO Members
POS and PPO plans offer members the choice to stay in-network or go out-of-network for services. See Information for POS Members  or Information for PPO Members  in the Member Guide or in the Member Information PDFs in Find a Doctor.

Procedures and equipment requiring Prior Authorization
Certain covered services require prior authorization from Unity to be considered for payment. This means that your physician must submit a Prior Authorization Request Form  to obtain approval before the service or equipment will be authorized for coverage. POS and PPO members are responsible for obtaining prior authorization.

Prior authorization lists differ depending on what type of health plan you have. If you are not sure what type of plan you have, refer to your Unity ID card; the plan type is indicated at the top of the card. You may also contact Unity Customer Service at 800-362-3310.

Access your health plan's prior authorization list:

Behavioral Health and AODA Services
Members who need behavioral health services or chemical dependency/alcohol and other drug abuse (AODA) services may call one number for assistance in scheduling an appointment:

Hospital Services
For elective (non-emergency) hospital inpatient services, your admitting physician must contact Unity for approval and precertification. Please access your plan's prior authorization list to see if the service requires prior authorization.