Attention Wauwatosa School District Employees

Wait, what?!?

Dear Wauwatosa School District teachers and employees…we hear you!

Your pediatricians at Tosa Pediatrics recently learned that Wauwatosa Schools District’s employee health plan (UHC Nexus) places Tosa Pediatrics “in Network” but at Tier 2. 

Good news!  Fortunately, it will not affect the cost of your ongoing preventative care with us.  It may, however, impact your acute illness/injury, mental health, and OT care.

 Here’s why…

Preventative care is covered and free for both Tier 1 and Tier 2.  

Vaccines are covered and free for both Tier 1 and Tier 2.  

Your deductibles (for illnesses, for example) are exactly the same for Tier 1 and Tier 2.

 Concerned about the out-of-pocket difference and that thing called co-insurance?  Read below, or call us and we can explain!  It’s confusing!

Regardless, feel confident in assigning your pediatrician at Tosa Pediatrics as your “Primary Care Physician” during your upcoming enrollment! If you don’t, you will be assigned a non-Tosa Pediatrics Tier 1 physician after 60 days.  But don’t worry, you can still switch back.

 Finally, please know, Tosa Pediatrics was not consulted during negotiations or before the final decision. While it is likely WSD will save money overall, we firmly believe and can demonstrate how using Tier 1 providers for general pediatrics will likely cost more for many WSD employees than the same services at Tosa Pediatrics. Tosa Pediatrics truly does provide “a better value for health care benefits”, and is committed to remain your family’s medical home despite this economic decision. In the ever-changing world of medicine, our promise is unwavering: to provide independent, personalized, and dependable care for your family in our Wauwatosa School District neighborhood. 

 More detailed information…

Confused or uncertain?.....We were, too! Simply call us!

 What about that out-of-pocket difference and that thing called co-insurance?  Won’t I pay more at Tosa Pediatrics?.....Initially, no.  But after hitting $1500 for your child or $3000 for your family, you might…

You only spend extra money IF your child or your family typically “hits deductible”.  What goes toward deductible are visits for illnesses, injuries, mental health services with our therapists, OT services…these are not considered preventative. To illustrate, IF, after all your check ups and vaccines, AND after using $1500 for a child (or $3000 for your family) for other non-preventative care in either Tier 1 or 2, you will have co-insurance kick in for Tier 2.  Co-insurance means your plan will cover 80% of your visit and you will be responsible for the other 20%.  Your copay is included in that 20%, NOT in addition to the 20%.  Remember, this only happens if you use $1500 of non-preventative care first for a child or $3000 for your family.  Most of our patients do not come to our clinic enough to surpass that $1500 for a child in a year.  So for most, a higher out-of-pocket maximum and co-insurance may be irrelevant.  But if your family is likely to hit the $1500/$3000, read on…

 What if I do go over the $1500 for a child or $3000 for my family in Tier 1 or 2?  Then won’t I pay more if I use Tosa Pediatrics for non-preventative care?  Yes, however…

First, we can work with you to prevent your needing to pay more, especially if your child uses Tosa Pediatrics frequently for multiple services beyond preventative care and vaccines.  Simply call us to see how.

Second, after the “$1500 child/$3000 family” deductible, on average, most non-preventative care visits in this case would cost you an estimated $40 or less at Tosa Pediatrics since your plan would still cover 80% of the visit.

Third, after the “$1500 child/$3000 family” deductible, you can choose to use a Tier 1 institution for virtual visits, urgent care, or ER for illnesses since there is no co-insurance or increased out-of-pocket expense.

Fourth, after the “$1500 child/$3000 family” deductible, you may opt to use Tier 1 institutional labs and imaging services, if needed, which we can help facilitate.  

Regardless, we can work with you to minimize any negative cost impact!  

How has Tosa Pediatrics partnered with WSD in the past and served our community?

• We have sponsored the District in the annual July 4 Parade

• We are annual bronze sponsors of the EFW

• We support East and West athletics

• We contribute to numerous PTA’s

• We support non-athletic organizations such as APPSE, music, and theater

• We offer provider shadowing for students interested in medicine

• We recently hosted a student team for LAUNCH  

• During the COVID pandemic, we offered to test and vaccinate ALL district employees and their families when their Tier 1 providers were either closed, full, or didn't even have testing.  By doing so, we returned teachers and students to their classroom days earlier, even those who do not routinely use Tosa Pediatrics.

• We served on the District's covid committee and were recognized by the Wauwatosa Library's Leadership Award in 2021.

• We hired 4 mental health providers to help with the COVID mental health fallout

For information on how to get the most out of your new WSD plan for your child, call us!  We can even help you personalize a strategic plan for your family!