WPS Health Insurance Review & Complaints: Health Insurance (2024)

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Wisconsin-based WPS Health Insurance provides a range of major medical and supplemental plans. Individual and family plans, group plans, and Medicare supplement are among their lineup offered to residents of their home state.

About WPS

Wisconsin Physicians Service (read our “Wisconsin Physicians Service (WPS) Insurance Review & Complaints: Medicare & Health Insurance” for more information) was founded in 1946, created by the State Medical Society to assist people who were unable to afford insurance. The not-for-profit was born in Milwaukee but moved its headquarters to Madison in 1950. As of 1977 they are no longer associated with the State Medical Society but continue to operate as a not-for-profit insurer across Wisconsin.

WPS is one of the largest providers of health insurance in the state. They are a government contracted Medicare administrator as well as offering a range of Medicare Supplement plans, and also administer VA health programs. Their individual and family plans include both standard PPO and HSA choices.

Some plans are offered through subsidiaries, such as EPIC Specialty Benefits. Additional health plan options can be explored through Arise Health Plan, which began serving Wisconsin residents in 2017 as Aspirus Arise after a merger.

WPS individual plans are available in specific counties, with a variety of networks choices, including local and statewide.

WPS Health Plans

As we have already reviewed WPS Medicare Supplement plans, this review will focus on their individual and family coverage options. WPS only appears to offer individual plans at the Bronze and Catastrophic levels according to their 2018 plan listing. All plans are PPO, offering in and out of network coverage. In network care will provide the most affordable medical care.

Bronze Plans

There are four Bronze plans with different deductible options available. The lowest deductible at this level is $4,500 individual. This plan has a 20% coinsurance amount that applies to nearly all services after the deductible is met. This is the only plan that has a higher out of pocket maximum than the deductible.

The next level is a high deductible plan with a $5,500 individual deductible and the same 20% coinsurance. The main difference with this plan is a lower maximum out of pocket cost.

The $6,650 and $7,350 deductible plans both offer 100% coverage after the deductible is met, with no coinsurance.

All of the Bronze plans have a $0 copay for preventative prescriptions, with all others subject to the deductible and coinsurance amounts.

Catastrophic Plan

Available only to those under 30, this plan has a $7,350 individual deductible, after which all services are covered in full. The same prescription drug benefits offered with the bronze plans also apply to the catastrophic plan.

Dental and Vision

All of the plans have the option to add on dental coverage offered through Delta Dental and EyeMed vision coverage at an additional cost. None of the plans include these benefits otherwise.

Rates

We ran a quick quote for one of the counties WPS covers – Monroe County – for a single 30-year-old non-smoker. The lowest rate returned by the search was for the PPO Bronze 7350 plan, with a monthly rate of $613.77.

This is far and away one of the highest rates we have seen in any state for a single person with a relatively high deductible plan. For comparison, another Wisconsin insurer, Dean Health Plan, offers a Bronze plan at $268 a month with a lower deductible (although it does have a 20% coinsurance). While county and the available network may not be comparable for these two quotes, there is a vast price difference that is difficult to account for. Again, competitor Dean Health offers a Gold plan that is still nearly $200 per month cheaper, and their most expensive plan comes in at $439 a month. Looking at those numbers, WPS rates are shockingly high.

Read more: WPS Health Insurance Review & Complaints: Health Insurance

WPS Health Insurance Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

WPS Health Insurance offers a straightforward claims process for its policyholders. Most claims are handled directly with the healthcare provider, which means that in many cases, policyholders do not need to be actively involved in the claims process. This is a common practice in the health insurance industry.

Average Claim Processing Time

WPS Health Insurance does not provide specific information about their average claim processing time on their website. Claim processing times can vary depending on the complexity of the claim, the healthcare provider, and other factors.

Policyholders are encouraged to reach out to WPS Health Insurance directly for information on claim processing times for their specific claims.

Customer Feedback on Claim Resolutions and Payouts

While there is limited information available regarding customer feedback on claim resolutions and payouts for WPS Health Insurance, it’s essential to note that the company has an A+ rating with the Better Business Bureau (BBB), and there are only two complaints on file in the past three years.

Additionally, there are no complaints closed in the past 12 months, which suggests that the company handles claims fairly and efficiently.

WPS Health Insurance Digital and Technological Features

Mobile App Features and Functionality

WPS Health Insurance provides a mobile app that offers various features and functionalities to enhance the customer experience.

While specific details about the app’s features are not provided in the provided content, it’s common for health insurance mobile apps to offer services such as claims tracking, policy management, finding in-network providers, and accessing digital insurance ID cards. Policyholders can download the app to access these features conveniently.

Online Account Management Capabilities

WPS Health Insurance offers online account management capabilities to its policyholders. This allows customers to access their policy information, view claims, make payments, and update their personal information through a secure online portal.

Online account management is a convenient way for policyholders to have easy access to their insurance details and perform essential tasks without the need for phone calls or physical paperwork.

Digital tools and resources

The content does not provide specific information about the digital tools and resources offered by WPS Health Insurance. However, many insurance companies provide online resources such as educational materials, wellness programs, and cost calculators to help policyholders make informed healthcare decisions and manage their coverage effectively.

Policyholders can explore the company’s website and online portal to access these digital tools and resources. Please note that for more detailed information about WPS Health Insurance’s claims process and digital features, it’s advisable for policyholders to visit the company’s official website or contact their customer service for specific inquiries.

The Bottom Line

WPS offers a limited selection of mainly Bronze plans with high deductibles. Their rates are much higher than what we have seen for other plans in the state, and are particularly high for the type of plan they offer. Although WPS ratings are generally good, there are plenty of highly rated plans with lower rates. Those looking for reasonably priced plans with a good choice of options might want to research other Wisconsin health insurance options and their rates.