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About Physicians Plus
Founded in 1986, Wisconsin-based Physicians Plus is an HMO insurance company providing coverage for the southern part of the state, including Madison where they are headquartered.
Physicians Plus is connected with the Meriter-Unity Point Health System and also works with several other local health systems. For a few years, Physicians Plus suffered due to the loss of a contract with UW Health, but that contract was reinstated in 2014. In the summer of 2017, Physicians Plus united with other local insurers Gunderson Health and Unity Health under the Quartz insurance brand. So far, they have retained the Physicians Plus name, but that is anticipated to change in the future.
Physicians Plus provides health insurance for more than 65,000 members in their service area.
Physicians Plus Products
Since Physicians Plus is in the process of re-branding to Quartz, the available products may change in the near future. For the purpose of this review, however, we chose an overview of products currently offered in Dane County – products in other counties may vary.
Physicians Plus has plans at every level, including a catastrophic plan option. These plans are HMO and do not offer coverage for out-of-network care.
They also offer Medicare coverage, which we have reviewed separately here.
There is one catastrophic plan available from Physicians Plus. This plan has a $7,350 individual deductible, $14,700 family. All services, with the exception of annual preventative care visits, are subject to the deductible, after which the plan covers care in full.
The Deductible Standard Bronze plan is much the same as the Catastrophic plan, with the same deductibles. Only preventative care is covered without the deductible applying. After the deductible is met, all services are covered in full.
The Deductible Plus Bronze plan has slightly lower deductibles at $7,000 individual and $14,000 family. This plan includes three pre-deductible primary care visits with a $50 copay, after which the deductible applies to all services. When the deductible is met, all services are covered in full.
The HSA Bronze plan is the only plan at this level offering the use of an HSA to pay out of pocket costs. The individual deductible is $6,550 and the family deductible $13,100. Similar to the higher deductible plan, coverage outside of preventative care is subject to the deductible, but these costs can be paid from a pre-tax HSA.
The Copay Primary Silver plan has a relatively high deductible of $6,850 individual but covers several services with a copay before the deductible is met. Primary care visits are covered with a $25 copay, although specialist visits are subject to the deductible. Prescription drug coverage starts at a $10 copay for generics.
There is a second version of the Copay Primary Silver plan with a lower deductible at $5,500 individual, but the primary care copay amount is higher at $30 per visit. Prescription coverage in this plan is the same, starting at $10.
The HSA Silver plan has a $4,000 individual deductible and $8,000 family deductible. All medical services aside from preventative care are subject to the deductible but can be paid from a pre-tax HSA account.
The Copay Value Silver plan has the lowest deductible of this level at $3,000 individual. Most services have a copay or coinsurance amount. Primary care visits have a $40 copay, while specialists have an $80 copay. Prescription drugs, like the Primary plans, start at a $10 copay.
There are three HSA plans available at the Gold level. The Gold 2700 Embedded plan has a $2,700 individual deductible and a $5,400 family deductible. Like all such plans, only preventative care is not subject to the deductible. The other two HSA plans are the family only and the member only. Like the names imply, these plans have one deductible only, either a $5,000 family or a $2,500 member.
The Copay Simple Gold plan has a $3,300 individual and $6,600 family deductible. Copays are $35 for primary care office visits and $70 for specialist visits. Prescriptions start at a $5 copay for generics.
There are two levels of the Copay Standard Gold plan. One has a $2,000 individual deductible, while the other has a lower $1,500 individual deductible. Copays vary slightly – the 2000 plan has a $35 primary care copay with $70 for a specialist visit. The lower deductible option also has lower copays at $30 for primary care and $60 for a specialist. Both plans offer the same Gold level prescription coverage starting at $5 for Tier 1 generics.
We attempted several times to obtain quotes from the Physician’s Plus online quoting system, but despite entering a variety of sample information, we repeatedly received a message saying no plans were available to meet the entered requirements. This may be due to the change over to Quartz that is in progress, or due to the sample information we used.
As a result of our inability to obtain rates for any of the plans, we are unable to provide a price comparison to other insurance companies in the area. And since this company is regional, we would not be able to compare to our usual sample area even if we were able to obtain rates.
There is also an online quoting system on the Quartz website, but it is unclear which of the plans, if any, that would be quoted are offered by Physician’s Plus.
Claims are handled directly by the provider and in the insurer, as with most health insurance. Since Physician’s Plus is an HMO and out-of-network care is not covered, it would be rare for a member to need to file any sort of reimbursement claim.
At the moment, there is no indication as to whether Quartz is involved in the claims process for Physician’s Plus plans.
Ratings and Consumer Reviews
Physician’s Plus has an A+ rating with the Better Business Bureau (BBB), and there is only one complaint on file in the past three years. Since there were no complaints at all when we last checked the company’s record, this complaint, which shows as closed in the past twelve months, is very recent.
There are a few scattered reviews of this company. Google has three reviews, all of which are negative and cite a small provider network and high costs. There are also three reviews on Yelp, where similar complaints are seen. Overall, there are not any major red flags in any of the reviews, and the complaint volume is not high.
The Bottom Line
Physician’s Plus is in a state of change, which will likely impact members in the near future. This change may, in fact, bring positives, such as an improved and larger provider network due to the connections with other regional insurers through Quartz. Currently, the company has a good reputation but is best for those who are okay with a smaller HMO network. Some potential new members may want to wait for the dust to settle before selecting this company for their insurance needs.
For a list of companies that we recommend, visit our Best Insurance Companies page.