Latest Announcements
ThedaCare Provider Updates 7/30/2010
Utilization Management Requests at Theda Clark Regional Medical Center and Appleton Medical Center - Effective for Dates of Service on or after August 1, 2010
All requests for elective procedures or services to be rendered by non-participating providers at a plan facility will be re-directed to participating providers at participating facilities. However, our Medical Director may approve requests for elective procedures or services if they are not available at in-network facilities.
Non-Participating Specialists include:
- Children’s Hospital of Wisconsin – Fox Valley and physicians
- Fox Valley Pulmonary Medicine, LLC
- Curtis Baltz, M.D.
- Radiation Oncology physicians of Appleton Radiology Associates (Radiation Oncologists on the campus of Appleton Medical Center)
All requests for elective procedures or services by participating providers at Theda Clark Regional Medical Center (TCMC) involving anesthesia services will be re-directed to participating facilities with participating anesthesia providers. Service requests involving anesthesia include but are not limited to:
- Surgical procedures
- Obstetrics – Deliveries
- Pain Clinic spinal procedures
Non-participating Anesthesiologists:
- Association of Hospital Anesthesiologists, S.C. (Anesthesiologists for Theda Clark Regional Medical Center)
Point-of-Service (POS) Plans
All requests for elective procedures or services involving non-participating anesthesia or independent providers for POS members may be approved based upon POS benefits and guidelines. Out-of-network benefits will apply for members with POS plans seeking procedures or services from a non-participating provider.
