Recommend a Provider

Tell us about the provider you are recommending:

"*" indicates required fields

First Name

Last Name

Provider Organization*

Provider Type

Address Line 1

Address Line 2

City

State

ZIP Code

Contact person at provider

First Name

Last Name

Phone

Tell us about yourself

Optional

First Name

Last Name

Address Line 1

Address Line 2

City

State

ZIP Code

The employer who offers you health coverage using The Alliance network

Are you currently seeing the provider you're recommending?

Yes

Recommend a Provider

If you learn that your health care provider is not part of The Alliance^® networks you can recommend them to be contacted by The Alliance. Unfortunately, this does not guarantee that a provider will become a part of our network. The Alliance determines provider network growth based on: employer needs and network adequacy for our enrollees. Any services provided will be billed at out-of-network rates until an agreement is reached between The Alliance and the recommended provider.

Fill out the form below to recommend a provider or you can call The Alliance at 800.223.4139 and ask to speak to Customer Service.

Our Customer Service Team

800.223.4139

Hours:
Monday-Thursday: 7:30am-4:30pm CST
Friday: 7:30am-11:30am CST

Our Addresses

Mailing Address:
PO Box 44365
Madison, WI 53744

The Alliance Office:
5510 Nobel Dr.
Suite 200
Fitchburg, WI 53711