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GHC-SCW 2013 Provider Directory2 0 1 3
2 For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
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about tHis directory This directory is accurate at the time of printing. Visit ghcscw.com to review availability of Provider panels. To verify the availability of a Primary Care Provider before completing your enrollment form, please call GHC–SCW Member Services.
Learn more about being a GHC–SCW member by reviewing your Membership Information booklet that you received as part of your enrollment materials. For complete details regarding what is covered under your GHC–SCW Plan, please refer to your Benefits Summary, Member Certificate and Plan Amendments, contact your employer, or call the GHC–SCW Member Services Department.
interPreter services Interpreter Services are provided at no charge to you. GHC–SCW does not discriminate on the basis of disability in the provision of programs, services or activities. If you need this printed material interpreted, in an alternative format, or need assistance in using any of our services, please contact GHC–SCW Member Services.
ESPAÑOL Si necesita ayuda para traducir o entender este texto, por favor llame al telefono (608) 828–4853 o (800) 605–4327, extensión 4504.
HMOOB Kev Pab Cuam Txhais Lusyuav muaj pab pub dawb rau koj. Xav tau phau txhais ua lwm hom lus los sis kom nkag siab no, thov hu (608) 663–2940.
Federal Employees: It is important to know that when you enroll in this Plan, services are provided through the Plan’s Provider Network as described in the Plan’s Federal brochure RI 73–061, but the continued participation of any one doctor, hospital or other Provider cannot be guaranteed. MyChart® is a registered trademark of Epic Systems Corporation. GHCMyChartSM is a service mark of Group Health Cooperative of South Central Wisconsin (GHC–SCW).
table of contents about your care ................................4–9 Networks ...............................................................4–5 Urgent Care & Emergency Care .............................6–7 GHC–SCW Pharmacy ................................................8
PriMary care section ....................10–22 Choosing the Right Provider .....................................11 GHC–SCW Primary Care Network ....................12–17 GHC–SCW Primary Care Clinics ....................... 12–13 GHC–SCW Primary Care Providers .................... 14–17 Capitol Clinic ...................................................... 14 Capitol Clinic Urgent Care ................................. 15 DeForest Clinic .................................................... 15 East Clinic ............................................................ 16 Hatchery Hill Clinic ...................................... 16–17 Sauk Trails Clinic ................................................. 17 UW Health–Family Medicine Network .....................18 UW Health–Cottage Grove Network ........................19 UW Health–Stoughton Network ..............................20 Access Community Health Centers Network ............21 Access–Wingra Family Medical Center Network ......22
sPecialty care section ..................23–49 GHC–SCW Specialty Care Locations ........................24 GHC–SCW Specialty Providers ..........................25–28 Chiropractic Providers ................................................ 25 Clinical Health Educators .......................................... 25 Dermatology Providers ............................................... 25 Domestic Violence Intervention Program ................. 27 Eye Care Providers ...................................................... 27 Mental Health Providers ...................................... 26–27 Occupational Therapy Providers ................................ 27 Physical Therapy Providers ........................................ 28 Podiatry Providers ....................................................... 28 GHC–SCW Complementary Medicine ................29–32 Complementary Medicine Services & Classes ........... 30 Complementary Medicine Providers .................... 31–32 Seeing a Specialist Outside of GHC–SCW .................33 Specialty Care Network Grid–All Networks ........34–49
GHCMyChartSM .................................................50–51 Wellness Reimbursement ..........................................52 Glossary .............................................................53–54
GHc–scw MeMber services PHONE: (608) 828–4853 (800) 605–4327, ext 4504 TDD (608) 828–4815
HOURS: Monday – Friday, 8 a.m. – 5 p.m.
3For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
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?new to GHc–scw? 1. ACTIVATE Your GHCMyChartSM Account With GHCMyChartSM, you may schedule appointments online, view selected test results, refill your prescriptions and more. See pages 50–51 for details. 2. CHOOSE a Primary Care Provider (PCP) GHC–SCW network Providers can be found in this Provider Directory. You have the right to choose any PCP who participates in your network and is available to accept you or your family members. Learn more about choosing a PCP on page 11. 3. TRANSITION Your Care To help you transition your care to GHC–SCW from your previous Provider(s), consider: • Do You Have Medical Records? Visit ghcscw.com, select the Privacy tab, then click on “Request for records from outside GHC–SCW” to authorize your previous Provider to release your medical records to GHC–SCW. • Do You Have an Existing Specialist? Visit ghcscw.com, select “Agent/Employer” under the Insurance Services section, then click on “Smooth Transition” to transition to a GHC–SCW Specialist or for continuity of your care. • Do You Have Existing Medications? See page 8 for GHC–SCW Pharmacy Services information. 4. MAKE An Appointment After you choose your Primary Care Provider (PCP), you may wish to schedule an appointment.
How to use tHis directory networks section (PaGes 4–5) GHC–SCW members can choose one of six possible networks. Your network is considered the path you take to receive needed care. To help you choose a network that works best for you, turn to pages 4–5. These pages list where to go for needed care depending on your network choice.
NETWORK LOCATIONS:
PriMary care section (PaGes 10–22) Primary Care Providers (PCPs) for all networks are located on pages 13–22. Choose a PCP based on your network choice. (See page 11 for details on choosing a PCP).
sPecialty care section (PaGes 23–49) The Specialty Care network grid for all networks is on pages 34–49. Use this grid as an easy way to find out where you may go for all types of care based on your network choice.
Bolded terms throughout this Provider Directory can be found in the glossary (see pages 53–54).
GHC Clinics UW Health – Family Medicine Clinics UW Health – Cottage Grove Clinic UW Health – Stoughton Clinic Access Community Health Centers Access – Wingra Family Medical Center H = Hospital Locations
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4 For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
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PriMary care Care must be received at: Capitol Clinic, DeForest Clinic, East Clinic, Hatchery Hill Clinic or Sauk Trails Clinic.
Care must be received at: Belleville Family Medical Clinic, Northeast Family Medical Center or Verona Family Medical Clinic.
Care must be received at: UW Health – Cottage Grove Clinic.
sPecialty care Prior Authorization may be required for some of these services.
Care must be received at GHC–SCW Clinics for: Chiropractic, Complementary Medicine, Dermatology, Clinical Health Education, Mental Health, Occupational Therapy, Optometry, Physical Therapy and Podiatry. Specialty Care is also provided by contracted Providers at UW Hospital and Clinics, UW Health Clinics or in some special cases, Meriter Clinics.
Care must be received at GHC–SCW Clinics for: Chiropractic, Complementary Medicine, Clinical Health Education, Mental Health, Occupational Therapy, Optometry, Physical Therapy and Podiatry. Specialty Care is also provided by contracted Providers at UW Hospital and Clinics, UW Health Clinics or Dean Medical Group.
Care must be received at GHC–SCW Clinics for: Chiropractic, Complementary Medicine, Dermatology, Clinical Health Education, Mental Health, Occupational Therapy, Optometry, Physical Therapy and Podiatry. Specialty Care is also provided by contracted Providers at UW Hospital and Clinics, UW Health Clinics or in some special cases, Meriter Clinics.
urGent and eMerGency care
For details regarding Urgent and Emergency Care, see pages 6–7.
For details regarding Urgent and Emergency Care, see pages 6–7.
For details regarding Urgent and Emergency Care, see pages 6–7.
inPatient care Care must be received at UW Hospital and Clinics or Meriter Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.
Care must be received at UW Hospital and Clinics or St. Mary’s Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.
Care must be received at UW Hospital and Clinics or Meriter Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.
inPatient labor and delivery care
Care must be received at St. Mary’s Hospital.
Care must be received at St. Mary’s Hospital.
Care must be received at St. Mary’s Hospital.
PHarMacy services
Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).
Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).
Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).
lab / radioloGy Care must be received at GHC–SCW Clinics.
Care must be received at your assigned UW Health – Family Medicine Clinic.
Care must be received at UW Health – Cottage Grove Clinic.
networks find your network–tHen refer to tHe cHart to see wHere you Go for needed care.
Prior Authorization may be required for some of these services. Please refer to your Benefits Summary and Member Certificate.
5For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
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ksnetworks find your network–tHen refer to tHe cHart to see wHere you Go for needed care.
Prior Authorization may be required for some of these services. Please refer to your Benefits Summary and Member Certificate.
Provider network
Care must be received at: UW Health – Stoughton Clinic.
Care must be received at: South Side Clinic or William T. Evjue Clinic.
Care must be received at: Access–Wingra Family Medical Center.
Care must be received at GHC–SCW Clinics for: Complementary Medicine, Clinical Health Education, Mental Health, Occupational Therapy, Optometry, Physical Therapy and Podiatry. Specialty Care is also provided by contracted Providers at UW Hospital and Clinics, UW Health Clinics or Dean Stoughton Clinic and Stoughton Hospital Rehab & Sports Medicine Clinic.
Care must be received at GHC–SCW Clinics for: Chiropractic, Complementary Medicine, Dermatology, Clinical Health Education, Mental Health, Occupational Therapy, Optometry, Physical Therapy and Podiatry. Specialty Care is also provided by contracted Providers at UW Hospital and Clinics, UW Health Clinics or in some special cases, Meriter Clinics.
Care must be received at GHC–SCW Clinics for: Chiropractic, Complementary Medicine, Clinical Health Education, Mental Health, Occupational Therapy, Optometry, Physical Therapy and Podiatry. Specialty Care is also provided by contracted Providers at UW Hospital and Clinics, UW Health Clinics or Dean Medical Group.
For details regarding Urgent and Emergency Care, see pages 6–7.
For details regarding Urgent and Emergency Care, see pages 6–7.
For details regarding Urgent and Emergency Care, see pages 6–7.
Care must be received at Stoughton Hospital, UW Hospital and Clinics, Meriter Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.
Care must be received at UW hospital and Clinics or Meriter Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.
Care must be received at UW Hospital and Clinics or St. Mary’s Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.
Care must be received at St. Mary’s Hospital.
Care must be received at St. Mary’s Hospital.
Care must be received at St. Mary’s Hospital.
Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).
Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).
Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).
Care must be received at UW Health – Stoughton Clinic.
Care must be received at South Side Clinic or William T. Evjue Clinic.
Care must be received at Access–Wingra Family Medical Center.
6 For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
GHc–scw urGent care clinic* (608) 257–9700 675 West Washington Ave., Madison, WI 53703 Monday – Friday, 8 a.m. – 9 p.m. Saturday – Sunday, 9 a.m. – 9 p.m.
*GHC–SCW Members who belong to the UW HEALTH – STOUGHTON network (Stoughton Clinic) may get Urgent Care at:
STOUGHTON HOSPITAL – URGENT CARE (608) 873–2264 900 Ridge St., Stoughton, WI 53589 6 a.m. – 11 p.m. (daily)
990 Janesville St., Oregon, WI 53575 Monday – Friday, 5 p.m. – 10 p.m. Saturday – Sunday, 12 p.m. – 10 p.m. OR GHC–SCW URGENT CARE CLINIC (608) 257–9700 675 West Washington Ave., Madison, WI 53703
need Medical care and not sure wHat to do?
urGent care How to Get urGent care Your first line of defense should be to call your Primary Care Clinic for an appointment (see the Reference Card on the back cover for clinic hours and numbers). If after hours, call the GHC–SCW Urgent Care Clinic* at (608) 257–9700.
wHat is urGent care? • Same–day or after hours care for conditions that require immediate attention • Care for non–life threatening conditions • Care for persistent or unusual discomfort associated with an illness • Physical Therapy in urgent care is available for some injuries
exaMPles: • Back Pain • Ear Pains • Migraine Headaches • Sore Throats • Colds and Flu • Eye Irritation • Simple Bone Fractures (not through skin) • Sprains • Cuts, Scrapes, Bruises • Fever • Skin Rashes • Urinary Burning
7For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
find your network clinic tHen Go to your desiGnated HosPital
GHC–SCW Clinics UW HEALTH – COTTAGE GROVE Clinics ACCESS COMMUNITY HEALTH CENTERS Clinics
UW HEALTH – FAMILY MEDICINE Clinics ACCESS–WINGRA FAMILY MEDICINE CENTER Clinic
UW HEALTH – STOUGHTON Clinic
call our 24–Hour nurse advice line, GHcnurseconnect. Coming January 2013! See page 9 for details.
Report Emergency Care and hospital admissions to GHC–SCW within 48 hours of receiving care or as soon as reasonably possible. Call the GHC–SCW Care Management Department at (608) 257–5294 or (800) 605–4327, ext. 4514. If after hours, please leave a message. Please note: If you fail to follow these procedures, you may be responsible for full payment of services.
eMerGency care How to Get eMerGency care If you require Emergency Care, please go to your designated hospital emergency room for treatment (see below). If this is not possible, go to the nearest hospital emergency room or call 911.
wHat is eMerGency care? Care for a life–threatening medical condition that includes severe symptoms, which could cause serious jeopardy to a person’s health.
exaMPles: • Alcohol/Drug Overdose • Facial or Eye Trauma • Loss of Consciousness • Severe Burns • Amputations or Severe Lacerations • Heart Attack/Chest Pain • Poisoning • Stroke • Complex Bone Fractures (through skin) • Knife/Gunshot Wounds • Respiratory Problems
UW HOSPITAL AND CLINICS (608) 263–6400 600 Highland Ave., Madison, WI 53792
OR MERITER HOSPITAL (608) 417–6000 202 S. Park St., Madison, WI 53715
UW HOSPITAL AND CLINICS (608) 263–6400 600 Highland Ave., Madison, WI 53792
OR ST. MARY’S HOSPITAL (608) 251–6100 700 S. Park St., Madison, WI 53715
STOUGHTON HOSPITAL (608) 873–2264 900 Ridge St., Stoughton, WI 53589
OR UW HOSPITAL AND CLINICS (608) 263–6400 600 Highland Ave., Madison, WI 53792
OR MERITER HOSPITAL (608) 417–6000 202 S. Park St., Madison, WI 53715
8 For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
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ac y GHc–scw PHarMacy
Prescription Drug Coverage is one of the many benefits GHC–SCW offers. To find out if prescription drugs are a covered benefit under your plan, refer to your GHC–SCW Benefits Summary,* which is included in your member materials. If your plan does have Prescription drug coverage, a basic list of covered drugs can be found on the GHC–SCW formulary.
new MeMber courtesy refill Your existing prescriptions may be temporarily honored, which gives you time to make an appointment with your Primary Care Provider. Bring your prescription bottle to any GHC–SCW Clinic Pharmacy and we will contact your existing pharmacy to transfer the prescription.
First time appointments: • Bring a medication list or existing medications to your first GHC–SCW appointment. • If you are taking medications not covered by GHC–SCW (non–formulary), contact GHC–SCW Pharmacy Administration or discuss with your Primary Care Provider.
to fill your PrescriPtion Order Online: Order your prescriptions online through your GHCMyChartSM account. (For sign–up information, see pages 50–51.) OR Order by Phone: Call your clinic Pharmacy to order your prescription.
GHc–scw PHarMacy locations & nuMbers
CAPITOL CLINIC Phone: (608) 257–9732 Address: 675 W. Washington Ave. Madison, WI 53703 Hours: Monday – Friday, 8 a.m. – 7 p.m. Saturday – Sunday, 9 a.m. – 5 p.m.
EAST CLINIC Phone: (608) 257–4829 Address: 5249 E. Terrace Dr. Madison, WI 53718 Hours: Monday, 8 a.m. – 7 p.m. Tuesday – Friday, 8 a.m. – 6 p.m.
HATCHERY HILL CLINIC Phone: (608) 661–7242 Address: 3051 Cahill Main Fitchburg, WI 53711 Hours: Monday, Wednesday, Thursday & Friday, 8 a.m. – 6 p.m. Tuesday, 8 a.m. – 7 p.m.
SAUK TRAILS CLINIC Phone: (608) 257–4869 Address: 8202 Excelsior Dr. Madison, WI 53717 Hours: Monday, 8 a.m. – 7 p.m. Tuesday – Friday, 8 a.m. – 6 p.m.
PHARMACY ADMINISTRATION Phone: (608) 828–4811 or (800) 605 4327, ext. 4811 Hours: Monday – Friday, 8 a.m. – 5 p.m.
Out–of–Area Emergency Prescription Drug Services: If you are out–of–area and require emergency prescription drug services, call GHC–SCW Urgent Care at (608) 257–9700, or contact Pharmacy Administration for details on how to proceed.
State of WI employees, UW Graduate Assistants, and local government employees (WPEG): Navitus Health Solutions administers the pharmacy benefit for participants covered under the State of Wisconsin Group Health Insurance Program. GHC–SCW Clinic Pharmacies are approved Navitus Providers and may be used for your prescription needs. For more information, please contact Navitus at (866) 333–2757 or visit navitus.com.
*Prescription drugs administered during a GHC–SCW–approved hospitalization will be subject to your plan’s Benefits for Inpatient/Outpatient Hospital Services. Please refer to your GHC–SCW Benefits Summary and Member Certificate for details.
Visit ghcscw.com and select “Pharmacy” for more information about
the GHC–SCW formulary, additional GHC–SCW Pharmacy services, and
information about GHC–SCW participating pharmacies (including
most major pharmacy chains).
STARTING JANUARY 2013 All clinics in the GHC–SCW
Network will have the flexibility and convenience to go to the participating
Pharmacy of their choice.
introducing your GHcnurseconnect team Your 24-hour Nurse Advice Line
GHcnurseconnect team (608) 661–7350 local or (855) 661–7350 toll-free
GHCNurseConnect is a new service designed to give you fast answers to your health-related questions. It’s staffed exclusively by nurses you already know and trust. And they’re all right here in Dane County – not a distant call center.
The goal? To give you the information you need when you need it. Maybe it saves you a trip to the Emergency Room or provides answers to your health concerns over the phone. We can even schedule an appointment with your GHC–SCW Provider to follow up with your medical issue.
GHCNurseConnect – another way that you and your GHC–SCW Care Team are Better Together.
coMinG January 2013! exaMPles of wHen to call:
• General care advice & triage • If you’re unsure if you need an appointment • Cough, cold, fever, flu, sore throat • Possible broken bones, sprains, urinary tract infections and head injuries • Other health-related issues
PriMarycare
11For a list of Providers, visit ghcscw.com and click on “Find a Provider.”
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GHC–SCW members have an assigned Primary Care Provider (PCP) for their care. Choosing the right PCP that meets your needs is important. By doing so, you create a relationship of trust and comfort between you and your PCP.
Get started 1. REVIEW PCPs in this Provider Directory. 2. ASK yourself if the following are important in your PCP choice: • Provider gender • Medical discipline (e.g. Family Medicine, Pediatrics) • Location • Medical interests 3. LEARN more about PCP options online: • More information about PCPs in this Provider Directory may be found at ghcscw.com under “Find a Provider.” Search by PCP name or by your network. 4. CHOOSE a PCP. To choose a PCP: • Log on to your GHCMyChartSM account (see pages 50–51 for sign up information) and select the “Message Center” tab, then type in your PCP request under “Contact Member Services”. • Or if you wish to discuss PCP options, call GHC–SCW Member Services at (608) 828–4853 or toll free at (800) 605–4327, ext. 4504.
As a GHC–SCW member, you may…