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Provider Manual

Sterilization: Hysterectomy Coverage

Last Updated on August 28, 2018

Security Health Plan covers hysterectomies. Prior authorization is not necessary, but providers must follow the mandated consent form requirements established by Medicaid fee-for-service. Consent form requirements are listed below along with Security Health Plan’s provider requirements.

Consent form requirements

  • The “Acknowledgement of Receipt of Hysterectomy Information” form must be completed prior to the procedure. The Acknowledgement of Receipt form, which is located in WMAP Provider Handbook-Physician Services-Medicine and Surgery section, may be photocopied.
  • The hysterectomy Acknowledgement of Receipt form does not require a waiting period prior to the procedure. 
  • The completed hysterectomy Acknowledgement of Receipt form found at the end of this section must be:
    • Faxed to Security Health Plan’s Claims Department at 1-715-221-9500, or
    • Mailed to: Security Health Plan Attn: Claims Department P.O. Box 8000 Marshfield, WI 54449-8000
  • The hysterectomy must be medically necessary and not solely for the purpose of rendering the patient sterile.

Provider requirements

  • The procedure must be performed by a Security Health Plan BadgerCare Plus affiliated provider.
  • No second opinions are necessary.

For more information, call Security Health Plan’s Claims Department at 1-800-791-3044.