WINHealth Partners

Frequently Asked Questions

Why is WINhealth Partners better than other health plans?

This sounds expensive. Can I afford this?

Is WINhealth Partners an HMO?

Do WINhealth Partner physicians see patients who are in other health plans?

Must I get permission from the health plan to receive the medical services I need?

Will I be covered when I'm out of town?

What do I do in an emergency?

What if I need special medical care that isn't offered through the network?

What about pre-existing medical conditions?

How much paperwork am I responsible for?

How do I enroll? If I don't choose a WINhealth Partners' plan now, can I choose it later?

What if my family status changes?

Why should I switch to WINhealth Partners?

Does low cost mean limited coverage?

What exactly is being managed in a managed care environment? The employer? The patients? The physicians?

What is the infrastructure of WINhealth Partners?

Why is WINhealth Partners better than other health plans?

For starters, because of the confidence you can place in our participating providers. The majority of your area physicians and the local hospital participate in our health plan. This level of involvement among local providers makes WINhealth Partners a plan that truly represents the needs of your community.

When designing WINhealth Partners, our providers placed member satisfaction first. That's why you can choose your own doctor, and why we pay in full for preventive care office visits that keep you at your healthiest. We want to detect and treat small problems before they turn into big ones!

This sounds expensive. Can I afford this?

Believe it or not, our health plan costs far less than most. There's no deductible, only a reasonable fixed amount--a copayment--for routine care, emergency or urgent care, or hospitalization.

Is WINhealth Partners an HMO?

WINhealth Partners offers two types of health plans: an HMO, and an HMO POS.
HMO is an acronym that stands for health maintenance organization. WINhealth Partners is licensed in the state of Wyoming as an HMO, and our emphasis is indeed on wellness. We do, however, have a model for accessing medical care that is state-of-the-art for HMOs: we are an open access system, meaning our members can select their own doctor from our participating physicians. Traditional HMOs require the selection of a primary care physician who serves as a "gatekeeper" for treatment options, including the need for specialty care. Unlike this gatekeeper model, our open access system relies on the dynamic relationship of members, providers, and employers working together to balance the need for medical services with appropriate, high-quality treatment options. Our HMO option does require that members stay in network, unless they are precertified for services we cannot provide locally.
Our HMO POS (point-of-service) option allows members to see any healthcare provider nationwide, as long as the service is a covered benefit under the plan. The only difference is that a deductible and coinsurance amount must be satisfied for out-of-network services before we reimburse fees.

Do WINhealth Partner physicians see patients who are in other health plans?

WINhealth Partners does not require the exclusive participation of its physicians. Many of our participating physicians work with other healthcare plans and insurance companies as they deem necessary.

Must I get permission from the health plan to receive the medical services I need?

Preauthorization is not required for routine office visits due to illness or injury. However, preauthorization is necessary for a scheduled hospitalization or surgery.

Will I be covered when I'm out of town?

When members are temporarily out of their local service area, their emergencies and urgent illnesses are covered. We only ask that members contact their physician or WINhealth Partners prior to obtaining emergency services, if possible, and prior to seeking urgent (non-emergency) services.

What do I do in an emergency?

The HMO definition of an emergency is a life- or limb-threatening situation. In the event of an emergency, whether inside or outside your local service area, you are asked to call your physician first. If you cannot call because of the catastrophic nature of the situation, call 911 or proceed to the nearest emergency room. We ask that you call your physician or WINhealth Partners within 48 hours after the event.

What if I need special medical care that isn't offered through the network?

With virtually every major medical specialty represented on our preferred provider list, it is likely that you'll find everything you need in your own community. However, if one of our physicians needs to refer you to an out-of-network provider for services that aren't provided locally, those charges will be considered in-network and will be fully covered.

What about pre-existing medical conditions?

If you have had continuous coverage under a qualified individual, group, or government-sponsored health plan to a date not more than 90 days prior to your effective date under a WINhealth Partners' plan and have satisfied the preexisiting waiting period for your condition under your former plan, there is no waiting period under our plan.

How much paperwork am I responsible for?

Great news: There is almost no paperwork! As long as you make your copayment at the time of service, there are no bills from the physician, and there are never any claim forms to submit. Just remember to carry your member identification card in your wallet so you can identify yourself as a WINhealth Partners' member whenever medical services are rendered.

How do I enroll? If I don't choose a WINhealth Partners' plan now, can I choose it later?

Our health plans are currently offered to employer groups with two or more employees. Employers can choose to participate at any time. After an employer signs on with WINhealth Partners, eligible employees must enroll within 30 days, or wait until the next open enrollment period.

What if my family status changes?

Just notify your employer, who will contact us to arrange the coverage you need. We will then send you an updated membership card.

Why should I switch to WINhealth Partners?

Because it's easier on your company's bottom line! With WINhealth Partners, you simply pay a low monthly premium, and your employees enjoy the benefits of a comprehensive health plan that significantly reduces their out-of-pocket expenditures while keeping them healthier, and more productive on the job!

With your local hospital and the majority of your area doctors on our preferred provider list, your employees will enjoy almost unlimited choice in selecting the provider who's right for them. They'll also appreciate the fact that there's no deductible in most of our plans: just a fixed amount--a copayment--every time they see their doctor. It's easy on your overhead and easy on your employees' checkbooks--a winning proposition for both of you!

Does low cost mean limited coverage?

Not at all! In fact, our health plan differs from most plans in providing generous coverage for preventive as well as corrective healthcare. Well-baby care, immunizations, routine check-ups, and mammography are covered because we believe regular check ups help prevent little problems from turning into big ones.

What exactly is being managed in a managed care environment? The employer? The patients? The physicians?

In a managed care environment, the processes of care are managed in an attempt to seek cost-effective approaches to preventive and curative care. In a fragmented, indemnity environment, there is no attempt, nor would it be possible, to bring processes into healthcare purchasing or treatment decisions. In a managed environment, the providers and the health data of its members function within the same system, allowing continual process management and improvement. An accountable managed plan is continually searching for best practice patterns and establishes performance benchmarks based on its own standards, as well as nationally published benchmarks for each process of care. In a managed environment, the process managers are not only the providers, but also the employer and members to the extent they are empowered by the health plan to have input regarding the management of their group.

What is the infrastructure of WINhealth Partners?

Its components are as follows:

The Health Plan. WINhealth Partners is nonprofit and is capitalized and self-governed by its participating hospitals and physicians. As such, the health plan does not have to focus on the need to generate dividends for out-of-state investors; rather, its sole motive is to improve the health status of the population in Wyoming and retain the high quality of the medical infrastructure currently operating in the region. Medical and operational decision making is done at the local level, meaning protocols are not developed by a distant, corporate third party but by providers who understand the health needs of the community.

WINhealth Partners offers two highly efficient managed plans: an HMO (health maintenance organization), and an HMO POS (point-of-service). Our HMO is an open-access system, meaning its members can select their own doctor from among our participating physicians. Traditional HMOs require the selection of a primary care physician who serves as a "gatekeeper" for treatment options, including the need for specialty care. Unlike this gatekeeper model, our system relies on the dynamic relationship of members, providers, and employers working together to balance the need for medical services with appropriate, high-quality treatment options. Our HMO option requires that members stay in network unless they are preauthorized for services we cannot provide locally. Our HMO POS option allows members to seek medical care anywhere in the nation, as long as the service is a covered benefit under the plan.

WINhealth Partners' emphasis is on wellness as the best approach to controlling costs. Our plan design and the orientation of our medical practices will emphasize preventive services to avoid the cost of catastrophic illness.

The Employer: Due to the increasing cost of providing healthcare, employers are now treating this expenditure more as an investment than simply the cost of doing business. As such, they expect to be informed about the status of their investment and what's being done to manage their investment wisely. WINhealth Partners intends to be in a dynamic relationship with its employers to provide consultative and reporting services so proactive solutions can be implemented for the employer's specific population. It is our belief that a healthier population will yield a greater return to the employer in terms of overall productivity.

The Member: Member dissatisfaction with health plans that prohibit them from selecting their own physician is well documented. Because WINhealth Partners believes strongly in the value of the traditional physician/patient relationship, its open-access system allows members to select their own doctor. Because the majority of local physicians are participants in our network, members will have almost unlimited choice in choosing their physician. WINhealth Partners believes that a long-term, collaborative relationship between a patient and their physician greatly enhances the process of preventive and appropriate curative care.

The Providers: The commitment of the WINhealth Partner providers is shown by their capital contribution to self-finance the health plan and share the financial risk for the health of its members. Not only will they provide patient care, but they will also participate in governing the health plan as members of internal committees concerned with such issues as care pathways, access, utilization management, quality improvement, and provider credentialing.