How to Fill Out and Submit the We Energies Medical Certification Form

The We Energies Medical Certification Form lets you postpone a utility shutoff when someone in your household has a medical condition that losing electric or gas service would worsen. You download the form from the We Energies website or request one by calling 800-842-4565, then three people fill it out: the patient, the account holder, and a physician or public health official. Once We Energies receives the completed form, disconnection is postponed for up to 21 days for a medical emergency, or for a full year if the patient qualifies as a critical care customer.¹²

The patient does not need to be the account holder. A spouse, child, parent, or roommate can be the protected person while someone else’s name is on the bill.

Choose the Right Category Before Your Doctor Signs

The form covers two situations, and the box your medical professional checks changes how long you are protected and how often you have to renew.

Medical emergency. The doctor certifies that an existing condition would worsen without service. Disconnection is postponed for up to 21 days. You can renew with a fresh certificate. In We Energies’ Upper Michigan service territory, consecutive medical emergency certificates cannot exceed 63 days total.¹
Critical care. Someone in the home depends on life-support equipment or a home medical device, and a power interruption would be immediately life-threatening. Protection runs on an annual basis; you renew once a year rather than every 21 days.²

If a household member uses a ventilator, oxygen concentrator, or dialysis machine, make sure the doctor checks critical care rather than medical emergency. It is a meaningful difference in duration and paperwork.

Who Can Sign the Medical Section

For Wisconsin customers, the certifier does not have to be a physician. Wisconsin rules allow a licensed physician, a public health official, a social services official, or a law enforcement official to identify the medical or protective services emergency and specify how long a shutoff would make it worse. The same rule applies to gas service under a parallel provision.³⁴

The form itself provides space for a physician or public health official’s credentials: name, license number, business address, and phone number.¹ If you cannot get a doctor’s appointment in time, a public health official is often the faster path.

Filling Out the Three Sections

All three sections must be complete and legible. Blank fields and unreadable handwriting are the most common reasons a form gets kicked back.

Section 1: Patient Information

The person with the medical condition fills this in and signs. For a patient under 18, a parent or legal guardian signs. If someone holds power of attorney for the patient, they can sign in the patient’s place. The section captures the patient’s name and establishes who in the household actually has the medical need.

Section 2: Account Holder Information

The customer of record fills out this section separately, providing printed name, service address, and account number, and signs even if they are not the patient. This is the section that lets a household protect a family member or roommate who is not on the bill.

Section 3: Medical Professional Certification

The physician or public health official completes this section after examining the patient. They list their name, license number, business address, phone, and fax. They then identify the medical condition, check whether the patient is a medical emergency patient or a critical care patient, and specify the time period during which a shutoff would worsen the condition. For a critical care patient, the certifier also lists the specific life-support equipment in use.¹

Submitting the Form

Once all three sections are signed, send the completed form and a valid form of identification to We Energies using one of these channels:

Secure email: MCCG-Incoming@we-energies.com
Fax: 414-221-3803
Secure upload through the We Energies payment assistance portal

If you already have a pending disconnection, you have three business days to get the completed form back to We Energies.⁵ We Energies processes completed forms within one business day of receipt.¹ When time is short, fax or secure email beats paper mail.

What Happens After Approval

An approved medical emergency certification postpones disconnection for up to 21 days. During that window, you and We Energies are expected to work together on a payment arrangement so service continues past the initial hold.³ If your service was already off when the form was submitted, the utility is required to reconnect it.

Critical care approval prevents disconnection on an ongoing basis for the year covered by the certification. Renewal is annual, with a new form each time.²

If We Energies needs more information, they may contact you or your medical professional directly. Tell the certifying office to expect a possible follow-up call so they can respond quickly.

Renewals and How Long Protection Can Last

For medical emergency certifications, the 21 days is not a hard ceiling in Wisconsin. The postponement can be extended by renewing the physician’s statement, provided you are communicating with We Energies and working toward a payment arrangement. Each renewal requires a fresh signed statement.³

In the Upper Michigan service area, consecutive medical emergency postponements cannot exceed 63 days total, even with renewals.¹ If the condition is ongoing and the patient qualifies, moving from medical emergency to critical care status provides more durable protection than stacking 21-day renewals.

You Still Owe for Service

The certification stops disconnection. It does not stop the bill. Wisconsin law is explicit that you remain responsible for the cost of utility service during the entire protection period.³ Customers under medical certification must be offered any special payment plan programs the utility makes available, so ask about a deferred payment agreement when We Energies contacts you during the postponement window. Staying engaged on payment is also what makes renewal possible, since continued postponement is tied to a reasonable effort to arrange payment.

Applying for energy assistance while a certification is active is worth doing. Contact We Energies at 800-842-4565 for a referral to programs like the Wisconsin Home Energy Assistance Program or the Keep Wisconsin Warm/Cool Fund.⁶⁷

If We Energies Disputes the Certification

If the utility challenges whether your situation qualifies, either you or We Energies can request an informal review by Wisconsin Public Service Commission staff. Your service must stay on during that review as long as you have submitted the required physician’s statement or official notice.³ A denial does not mean immediate shutoff.

What the Certification Does Not Do

Medical certification does not put your address at the front of the line for restoration during a storm or grid outage. If your neighborhood loses power, your certification status has no effect on the repair queue. For households that rely on life-support equipment, a battery backup or generator is the only reliable safeguard against unplanned outages, and providing that equipment is the household’s responsibility, not the utility’s.

A separate Wisconsin cold weather rule limits disconnections between November 1 and April 15, but it applies based on household income and health-and-safety considerations rather than medical status.⁸ It can serve as a backstop if a medical certification lapses in winter, but income thresholds may disqualify you, so keeping the certification current is safer than relying on it.

1
Upper Michigan Energy Resources Corporation. Medical Certification Form
2
We Energies. Critical Care Customer Shut-off Protection – Michigan
3
Wisconsin State Legislature. Wisconsin Administrative Code PSC 113.0301
4
Wisconsin State Legislature. Wisconsin Administrative Code PSC 134.062
5
We Energies. Michigan Medical Emergency Protection
6
We Energies. Wisconsin Energy Assistance
7
We Energies. Payment Arrangements and Energy Assistance
8
Wisconsin State Legislature. Wisconsin Administrative Code PSC 113.0304