Download pdf - Provider and network directory

Provider and network directoryHMo

2013

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 contentsabout your care ................................4–9Networks ...............................................................4–5Urgent Care & Emergency Care .............................6–7 GHC–SCW Pharmacy ................................................8

PriMary care section ....................10–22Choosing the Right Provider .....................................11GHC–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 .....................18UW Health–Cottage Grove Network ........................19UW Health–Stoughton Network ..............................20Access Community Health Centers Network ............21Access–Wingra Family Medical Center Network ......22

sPecialty care section ..................23–49GHC–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 ....................................................... 28GHC–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 .................................................50–51Wellness Reimbursement ..........................................52Glossary .............................................................53–54

GHc–scwMeMber 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: •DoYouHaveMedicalRecords? 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. •DoYouHaveanExistingSpecialist? 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. •DoYouHaveExistingMedications? 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 directorynetworks 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 ClinicsUW Health – Family Medicine ClinicsUW Health – Cottage Grove ClinicUW Health – Stoughton ClinicAccess Community Health CentersAccess – Wingra Family Medical Center H = Hospital Locations

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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.


urGent and eMerGency care

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.



PHarMacy services

Receive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see pg. 8 for details).



lab / radioloGyCare 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.

networksfind 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.


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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 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 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.


GHc–scw urGent care clinic*(608) 257–9700675 West Washington Ave., Madison, WI 53703Monday – 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) 873–2264900 Ridge St., Stoughton, WI 535896 a.m. – 11 p.m. (daily)

990 Janesville St., Oregon, WI 53575Monday – Friday, 5 p.m. – 10 p.m.Saturday – Sunday, 12 p.m. – 10 p.m. ORGHC–SCW URGENT CARE CLINIC(608) 257–9700675 West Washington Ave., Madison, WI 53703

need Medical care and not sure wHat to do?

urGent careHow 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–dayorafterhourscareforconditionsthatrequireimmediateattention •Carefornon–lifethreateningconditions • Care for persistent or unusual discomfort associated with an illness •PhysicalTherapyinurgentcareisavailableforsomeinjuries

exaMPles: •BackPain •EarPains •MigraineHeadaches •SoreThroats •ColdsandFlu •EyeIrritation •SimpleBoneFractures(not through skin) •Sprains •Cuts,Scrapes,Bruises •Fever •SkinRashes •UrinaryBurning


find your network clinic tHen Go to your desiGnated HosPital

GHC–SCW ClinicsUW HEALTH – COTTAGE GROVE ClinicsACCESS COMMUNITY HEALTH CENTERS Clinics

UW HEALTH – FAMILY MEDICINE ClinicsACCESS–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. Pleasenote:Ifyoufailtofollowtheseprocedures,youmayberesponsibleforfullpaymentofservices.

eMerGency careHow to Get eMerGency careIf 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/DrugOverdose •FacialorEyeTrauma •LossofConsciousness •SevereBurns •AmputationsorSevereLacerations •HeartAttack/ChestPain •Poisoning •Stroke •ComplexBoneFractures(through skin) •Knife/GunshotWounds •RespiratoryProblems

UW HOSPITAL AND CLINICS(608) 263–6400600 Highland Ave., Madison, WI 53792

ORMERITER HOSPITAL (608) 417–6000202 S. Park St., Madison, WI 53715

UW HOSPITAL AND CLINICS (608) 263–6400600 Highland Ave., Madison, WI 53792

ORST. MARY’S HOSPITAL (608) 251–6100700 S. Park St., Madison, WI 53715

STOUGHTON HOSPITAL (608) 873–2264900 Ridge St., Stoughton, WI 53589

ORUW HOSPITAL AND CLINICS(608) 263–6400600 Highland Ave., Madison, WI 53792

ORMERITER HOSPITAL(608) 417–6000 202 S. Park St., Madison, WI 53715


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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 refillYour 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: •BringamedicationlistorexistingmedicationstoyourfirstGHC–SCWappointment. •IfyouaretakingmedicationsnotcoveredbyGHC–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 2013All clinics in the GHC–SCW

Network will have the flexibility and convenience to go to the participating

Pharmacy of their choice.

9

introducing your GHcnurseconnect teamYour 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 BetterTogether.

coMinGJanuary 2013!exaMPles of wHen to call:

• Generalcareadvice&triage• Ifyou’reunsureifyouneed an appointment• Cough,cold,fever,flu,sorethroat• Possiblebrokenbones,sprains, urinary tract infections and head injuries• Otherhealth-relatedissues

PriMarycare


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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: • Providergender •Medicaldiscipline(e.g.FamilyMedicine,Pediatrics) • Location •Medicalinterests 3. LEARN more about PCP options online: •MoreinformationaboutPCPsinthisProviderDirectorymaybefound at ghcscw.com under “Find a Provider.” Search by PCP name or by your network. 4. CHOOSE a PCP. To choose a PCP: • LogontoyourGHCMyChartSM 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”. •OrifyouwishtodiscussPCPoptions,callGHC–SCWMemberServicesat(608)828–4853 or toll free at (800) 605–4327, ext. 4504.

As a GHC–SCW member, you may change your PCP and clinic location within your network at any time.

PcPs exPlainedA Primary Care Provider (PCP) provides and coordinates your general care. Qualified PCPs include: • Physician – Doctor of Medicine (MD) is a qualified, health care professional licensed to provide the full scope of medicine and surgery. – Doctor of Osteopathy (DO) is a qualified, health care professional licensed to provide the full scope of medicine and surgery. DOs place emphasis on the whole person and they strive to restore health, often incorporating improvement in musculoskeletal function and balance. • Certified Physician Assistant (PA–C) is a qualified, licensed health care professional with academic training and clinical experience. A PA–C provides a range of services such as routine physical examinations, evaluation, and management of common medical problems and clinical health education. • Advanced Practice Nurse Prescriber (APNP) is a qualified, licensed health care professional with academic training and clinical experience. An APNP provides a range of services such as routine physical examinations, evaluation, and management of common medical problems and clinical health education.

PCPs focus on one of the following: • Family Medicine focuses on health care for the entire family, with an emphasis on continuity of care for all ages. • Family Medicine with Obstetrics focuses on health care for the entire family, with an emphasis on delivering babies. • Internal Medicine focuses on adult medicine and complex health care. Older adults may prefer Internal Medicine because of its focus on the interrelated systems of the body and how they are affected by illness. • Pediatrics focuses on childhood medicine and health care (including preventive services). A Pediatric PCP may be ideal for children ages 17 or younger.


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Refer to the chart below to see where you go for needed care.


GHc–scw care teaMs (PaGes 14–17)Throughout pages 14–17, you will find GHC–SCW Providers arranged according to care teams. A care team is a team approach to patient care that uses the expertise and skills of all health care staff to better serve members. Care teams allow staff to work in a more coordinated way to provide better member satisfaction, better access to Providers and better health care for our members.

Who’s on your Care Team?

• Primary Care Providers (PCPs) coordinate care on a care team. PCPs include Physicians (MDs/DOs), Certified Physicians Assistants (PA–Cs), or Advance Practice Nurse Prescribers (APNPs).

• RN Coordinators assist patients with complex health questions and needs, and they coordinate with PCPs as needed. This team member is a Registered Nurse (RN).

• Case Managers assist members with hospitalization needs, referral questions, follow–up care, and transitioning of care among various health care Providers.

• Clinical Staff coordinate with PCPs to help with patient communication. Team members include Licensed Practical Nurses (LPNs) and Certified Medical Assistants (CMAs).

If a PCP is unavailable in the clinic, staff on the care team will monitor messages, test results and prescription refill requests to ensure member needs are met in a timely fashion.

GHc–scw clinics

PriMary care Please see page 13 for a listing of available Primary Care Providers.

Care must be received at: Capitol Clinic, DeForest Clinic, East Clinic, Hatchery Hill Clinic or Sauk Trails 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 non–GHC–SCW Providers at UW Hospital and Clinics, UW Health Clinics or is some special cases, Meriter Clinics.

urGent & eMerGency care For details regarding Urgent and Emergency Care, see pages 6–7.




PHarMacy servicesReceive prescriptions through GHC–SCW Clinic Pharmacies and/or GHC–SCW–participating pharmacies (see page 8 for details).

lab / radioloGyCare must be received at GHC–SCW Clinics.


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caPitol clinicPhone: (608) 257–9700Address: 675 W. Washington Ave. Madison, WI 53703Hours: Monday, Wednesday, Friday, 8 a.m. – 5 p.m. Tuesday & Thursday, 8 a.m. – 7 p.m.

FAMILY MEDICINE Terence Galka, PA–CJack Hayes, PA–CRobert Matthew, MDJohn Perry, PA–CHolly Schmidt, APNP Monique Simmons, APNP Michelle Thomas, MD Julie Vander Werff, PA–CPatricia Witte, MD

FAMILY MEDICINE WITH OBSTETRICS Michele Brogunier, MDRebecca Bull, MDLeah Ederer, MDRosemarie Schumacher, MDMonica Vohmann, MD

INTERNAL MEDICINEDavid Eckerle, MDDeborah Williams, MD

PEDIATRICSArnold Benardette, MDAlison Craig, MD

deforest clinic Phone: (608) 846–4787Address: 815 South Main St. DeForest, WI 53532Hours: Monday – Friday, 8 a.m. – 4:30 p.m.

FAMILY MEDICINE & GERIATRICS Scott Miller, MD

FAMILY MEDICINE Julie Vander Werff, PA–C

east clinicPhone: (608) 222–9777Address: 5249 East Terrace Dr. Madison, WI 53718Hours: Monday, 9 a.m. – 7 p.m. Tuesday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINEMarcia Bolles, PA–CNancy Deaton, MDJeanette Everson, MDMary Evenson, PA–CJeff Huebner, MDAllison Philipps, APNPMarilee Thoresen, PA–C

FAMILY MEDICINE WITH OBSTETRICSGeorge Leydon, DOStephanie Skladzien, MD

INTERNAL MEDICINEHolly Benson, MD

PEDIATRICSRenee Burk, MDKristin Seaborg, MD

HatcHery Hill clinicPhone: (608) 661–7200Address: 3051 Cahill Main Fitchburg, WI 53711Hours: Mon, Wed– Friday, 8 a.m. – 5 p.m. Tuesday, 8 a.m. – 7 p.m.

FAMILY MEDICINECarol Ballweg, APNPJon Bohman, PA–CKathryn Burrs, APNPMark Huth, MDMark Olinger, MDL. Nisha Rajagopalan, MDJulie Sager, MDDebra Shenoi, MDPam Sprecher–Galka, PA–C

FAMILY MEDICINE WITH OBSTETRICSEric Hilquist, MD

PEDIATRICSStephen Lo, MD

sauk trails clinicPhone: (608) 831–1766Address: 8202 Excelsior Dr. Madison, WI 53717Hours: Monday, 8 a.m. – 7 p.m. Tuesday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINEWard Dieter, PA–CIvy Dowd, PA–CCrystal Frohmader, PA–CAnn Stein, MDTeresa Sizer, MDMary–Anne Urtes, MDMegan Weimer, APNP

FAMILY MEDICINE WITH OBSTETRICSChristian Kastman, MD

INTERNAL MEDICINE & GERIATRICSClaudiu Gherlan, MD

PEDIATRICSAnn Behrmann, MDMala Mathur, MD

GHc–scw PriMary care clinics & ProvidersSee page 11 for a description of Primary Care Providers.


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Rebecca Bull, MDFamily Medicine with Obstetrics

Robert Matthew, MD

Family Medicine

Monica Vohmann, MD

Family Medicine with Obstetrics

Julie Vander Werff, PA–C

Family Medicine

Paul Steichen,RN

Lisa Van Natta,RN

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Leah Ederer, MDFamily Medicine with Obstetrics

Terence Galka, PA–C

Family Medicine

Rosemarie Schumacher, MDFamily Medicine with Obstetrics

Holly Schmidt,APNP

Family Medicine

Karen Cooper,RN

Mary Knispel,RN

Michelle Thomas, MD

Family Medicine

Joyce Lynch, RN

Jillian Jurgens, RN

John Perry, PA–C

Family Medicine

Patricia Witte, MDFamily Medicine

David Eckerle, MD

Internal Medicine

Jack Hayes, PA–C

Family Medicine

Deborah Williams, MD

Internal Medicine

Nancy Hoenisch, RN

Alison Craig, MDPediatrics

Arnold Benardette, MD

Pediatrics


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Terence Galka, PA–C Ted Haglund, MD Pam Heilman, MD Jolene Huber, PA-C Kris Knoepke, MD

James Long, MD Amy Wagner, PA–C, MPAS

Photo not available: Stephanie Salas, PA–C; Aimee Passini, PA–C

Bonnie Sommers–Olson, APNP

Scott Miller, MDFamily Medicine/

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Julie Vander Werff, PA–C

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Becky Dorn,RN

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Leslie Anderson,CSW


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Marcia Bolles,PA–C

Nancy Deaton, MD

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Jeanette Everson, MD

Kristin Seaborg, MD

Pediatrics

Marilee Thoresen, PA–C

Family Medicine

Becky Dorn,RN

Holly Benson,MD

Internal Medicine

Allison Philipps,APNP

Family Medicine

Jeff Huebner,MD

Family Medicine

Mary Evenson, PA–C

Stephanie Skladzien, MD


Nettie Beyer,RN

George Leydon, DOFamily Medicine with Obstetrics

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Jon Bohman, PA–CFamily Medicine

Mark Huth, MDFamily Medicine

Ann Statz,RN

Mark Olinger, MDFamily Medicine

Stephen Lo, MDPediatrics

Eric Hilquist, MD Family Medicine with Obstetrics

Carol Ballweg, APNP

Family Medicine

Katie Burrs, APNP Family Medicine

Jill Nilsson,RN

Joan Young, APNPPrenatal Coordinator/Lactation Consultant

Julie Sager, MDFamily Medicine

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Leslie Anderson, CSW

east clinic

HatcHery Hill clinic


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redwood teaM

L. Nisha Rajagopalan, MD

Family Medicine

Deb Shenoi, MDFamily Medicine

Pam Sprecher, PA–C

Family Medicine

Carolyn Hedrington,RN

Nichole Nellen,RN

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OV

IDE

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RN

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east clinic


Rebecca Connors, RN, BS, CCM

Lisa Behl, RN, BSN, CCM

Ivy Dowd, PA–CFamily Medicine

Christian Kastman, MDFamily Medicinewith Obstetrics

Ann Stein, MDFamily Medicine

Alicia Hynek,RN

Mary Hedrick,RN

Crystal Frohmader, PA–C

Family Medicine

MaGnolia teaM

Ward Dieter, PA–CFamily Medicine

Claudiu Gherlan, MDInternal Medicine

and Geriatrics

Teresa Sizer, MDFamily Medicine

PalM teaM

Ann Behrmann, MDPediatrics

Mala Mathur, MDPediatrics

Megan Weimer, APNP Family Medicine

Mary Anne Urtes, MDFamily Medicine

sassafras teaM

PR

OV

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PR

OV

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RS

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RN

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RN

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case ManaGer

sauk trails clinic



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uw HealtH – faMily Medicine

PriMary care See below for a listing of Primary Care Providers.

Care must be received at: Belleville Family Medical Clinic, Northeast Family Medical Center or Verona Family Medical Clinic.




inPatient care 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.




lab / radioloGyCare must be received at your assigned UW Health – Family Medicine Clinic.

uw HealtH – faMily Medicine network Refer to the chart below to see where you go for needed care.

BELLEVILLE FAMILY MEDICAL CLINICPhone: (608) 424–3384Address: 1121 BellWest Blvd Belleville, WI 53508Hours: Monday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINEByron Crouse, MDDavid Deci, MDValerie Gilchrist, MDStephen Olcott, MDMelissa Stiles, MD

FAMILY MEDICINE WITH OBSTETRICSSarah GaleWryck, MD Jennifer Lochner, MDRichard Roberts, MD

NORTHEAST FAMILY MEDICAL CENTERPhone: (608) 241–9020 Address: 3209 Dryden Dr. Madison, WI 53704Hours: Monday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINECaitlin D’Agata, MD Russell Lemmon, DO Ashley Lienhardt, PA–CJeffrey Patterson, MD Shannon Reed, DOJoan Uminski, PA–CMaureen Van Dinter, APNPJo Ann Wagner–Novak, APNP

FAMILY MEDICINE WITH OBSTETRICSJennifer Edgoose, MDRonni Hayon, MDKathy Oriel, MDDavid Rabago, MDLouis Sanner, MD

UW HEALTH VERONAPhone: (608) 845–9531Address: 100 N. Nine Mound Rd. Verona, WI 53593Hours: Monday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINEBruce Barrett, MDJohn Beasley, MDKathleen Carr, MDJanice Cooney, PA–CEllen Evans, PA–CSarah James, DOJason Ricco, MDHeidi Stokes, PA–CKaren Wendler, PA–C

FAMILY MEDICINE WITH OBSTETRICSJane Anderson, MDBrian Arndt, MDAnn Evensen MD William Scheibel, MDDouglas Smith, MD

Sarina Schrager, MDWilliam Schwab, MD


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uw HealtH – cottaGe Grove


Care must be received at: UW Health – Cottage Grove Clinic.


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 non–GHC–SCW Providers at UW Hospital and Clinics, UW Health Clinics or is some special cases, Meriter Clinics.






lab / radioloGyCare must be received at: UW Health – Cottage Grove Clinic.

uw HealtH – cottaGe Grove networkRefer to the chart below to see where you go for needed care.

COTTAGE GROVE CLINICPhone: (608) 839–3104Address: 500 Westlawn Dr. Cottage Grove, WI 53527Hours: Monday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINELouis Falligant, PA–CEdward Kramper, MD


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UW HEALTH – STOUGHTON CLINICPhone: (608) 877–2660Address: 1001 Nygaard St. Stoughton, WI 53589Hours: Monday – Friday, 8 a.m. – 5 p.m.

FAMILY MEDICINEGeorge Gay, MDDanalyn Rayner, MD

INTERNAL MEDICINEKaren Griffin, PA–CAhsan Khalid, MD

PEDIATRICSAnne Means, MDKaren Pletta, MDPrasanna Raman, MD


uw HealtH – stouGHton networkRefer to the chart below to see where you go for needed care.

uw HealtH – stouGHton


Care must be received at: UW Health – Stoughton Clinic.


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.


inPatient care Care must be received at Stoughton Hospital, UW Hospital and Clinics or Meriter Hospital. Members who are more than 20 weeks pregnant must deliver at St. Mary’s Hospital.




lab / radioloGyCare must be received at: UW Health – Stoughton Clinic.


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SOUTH SIDE CLINICPhone: (608) 443–5480Address: 2202 S. Park St. Madison, WI 53713Hours: Monday – Friday, 8 a.m. – 5 p.m. Some evening hours

FAMILY MEDICINEDon Carufel–Wert, MDWilliam Kinsey, MDKen Loving, MDSarah Rowe, NP.Anne Slaughter–Perrote, PA–CRebecca Tharaud, MD

PEDIATRICSDipesh Navsaria, MD

WILLIAM T. EVJUE CLINICPhone: (608) 443–5480Address: 3434 E. Washington Ave. Madison, WI 53704Hours: Monday – Friday, 8 a.m. – 5 p.m. Some evening hours

FAMILY MEDICINEVanessa Chen, PA–CCarey Dachik, PA–CKevin Fehr, MDCynthia Galloway, APNPMollie Kane, MDKen Loving, MDNancy Pandhi, MDElizabeth Poi, MDAlexander Young, MD

FAMILY MEDICINE WITH OBSTETRICSLana Doxtater, MD

PEDIATRICSJames Omohundro, MD


access coMMunity HealtH centers networkRefer to the chart below to see where you go for needed care.

access coMMunity HealtH centers


Care must be received at: South Side Clinic or William T. Evjue Clinic.


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 non–GHC–SCW Providers at UW Hospital and Clinics, UW Health Clinics or is some special cases, Meriter Clinics.






lab / radioloGyCare must be received at: South Side Clinic or William T. Evjue Clinic.


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access–winGra faMily Medical center networkRefer to the chart below to see where you go for needed care.

access–winGra faMily Medical center


Care must be received at: Access–Wingra Family Medical Center.




inPatient care 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.




lab / radioloGyCare must be received at: Access–Wingra Family Medical Center.

ACCESS–WINGRA FAMILY MEDICAL CENTERPhone: (608) 263–3111Address: 701 Dane St. (2100 block of S. Park St. at Dane St.) Madison, WI 53713Hours: Monday – Friday, 8:30 a.m. – 5 p.m.

FAMILY MEDICINERandall T. Brown, MDJessica Dalby, MD Mary Giblin, PA–CJoel Hill, PA–CJonas Lee, MDDavid Lessens, MDAndrea Martonffy, MDJonathan Temte, MDAngela Vitcenda, PA–C

FAMILY MEDICINE WITH OBSTETRICSLee Dresang, MDBeth Potter, MDKirsten Rindfleisch, MDPatricia Tellez–Giron, MD

sPecialtycare


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s GHc–scw sPecialty care locations Services vary by GHC–SCW clinic.

cHiroPractic (page 25) Capitol ClinicEast ClinicSauk Trails ClinicHatchery Hill Clinic

clinical HealtH education (page 25)Capitol ClinicEast ClinicSauk Trails ClinicHatchery Hill Clinic

coMPleMentary Medicine (page 31–32)See pages 29–30 for details.

derMatoloGy (page 25)Hatchery Hill Clinic

eye care center (page 27)Hatchery Hill Clinic

GHc–scw locations & nuMbers CAPITOL CLINICPhone: (608) 257–9700Address: 675 West Washington Ave. Madison, WI 53703

CAPITOL REGENT MENTAL HEALTH CLINICPhone: (608) 441–3290Address: 700 Regent St. Madison, WI 53703

EAST CLINICPhone: (608) 222–9777Address: 5249 East Terrace Dr. Madison, WI 53718

HATCHERY HILL CLINICPhone: (608) 661–7200Address: 3051 Cahill Main Fitchburg, WI 53711

PRINCETON CLUB WEST PT/OT CLINIC Phone: (608) 662–5060Address: Princeton Club West 8054 Watts Rd. Madison, WI 53719

SAUK TRAILS CLINICPhone: (608) 831–1766Address: 8202 Excelsior Dr. Madison, WI 53717

Mental HealtH (page 26–27)East ClinicSauk Trails ClinicCapitol Regent Mental Health ClinicHatchery Hill Clinic

occuPational tHeraPy (page 27)Capitol ClinicEast ClinicPrinceton Club West PT/OT Clinic

PHysical tHeraPy (page 28)Capitol ClinicEast ClinicPrinceton Club West PT/OT Clinic

Podiatry (page 28)East ClinicSauk Trails ClinicHatchery Hill Clinic


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Michael Wirth, DC

Dan Olson, DC

Peter Leonhard, DC

Daniel Futch, DC

Kelly Andrews, DC

GHc–scw cHiroPractic Providers

Christine Tock, MD, PhD

Lai Thao, PA–C

GHc–scw derMatoloGy Providers

Barb Lazaris, MS, LPC

Carly DeGrood, MS, RD, CD, CDE

Lisa Hansen,RD, CD,

IBCLC, RLC

Tim Ballweg, RRT, CPFT, AE–C

Ruby Bradt Vanderzee, ICCE

Anne Marie (Dolly) Wagner, ICCE

Donna Twining,APNP, CDE

Diane Lillis,APNP

Deborah Roussos, MS, RD, CD

Kelly Smith,RN, BSN, CDE

Laurie deFiebre,BSN, RN

Julie McLaughlin, MS, RD, CD, CDE

clinical HealtH education Providersadvanced diabetes ManaGeMent

astHMa educator

diabetes nurse educators

reGistered dietitianstobacco cessation counselor

cHildbirtH educators

advanced PreventivecardioloGy


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Richard Adelman,MSSW, LCSW

Jeff Anders, MD

Stephen Billingham, PhD

Graham Cody,MD

Caitlin Stone,PhD

Kathryn Coleman,MSSW, LCSW

Floriane d’Oleire,MD

Ralph Froelich,MD

Karla Handel,MSSW, LCSW

Lisa Hunter,MD

Michael Hussey,LCSW, CSAC

Paul Johnson,LCSW, CSAC

Sam Mak,LCSW, CSAC

Sven Midelfort,MSSW, LCSW

Danielle Ogno,LCSW, LMFT

Carlene Oakley, MD

Michelle O’Meara,LCSW, LMFT

Barbara Roth,MSSW, LCSW

Dianne Ruch,PhD, APNP

Nancy Schiro,MSN, LCSW

Ed Sheldon,MD

Michael Smith,EdS, LPC

Deborah Sullivan,MS, LCSW

Judith Utevsky,MSW, LCSW

Peter Weiss, PhD

Bill Windels,APNP

Nancy Yaffe,MS, LPC

Bethany Fucci,MA, LPC

Amy Bourne,MD

Jennifer Brandt,CPNP, PMHNP–BC

Sarah Strong,MSSW, LCSW


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Kelsey Barnes,OD

Lisa Mowbray,MSSW, LCSW

Certified Batterer Treatment Provider

Mark Seymour, MS, LCSW

Certified Batterer Treatment Provider

Nathan Catterson,OD, FAAO

John Dabel,OD

Brady Haferman,OD

Sacha Lundgren,OD

Robert Mertz,OD

Timothy Schwefel,OD, FAAO

Kurt Walters,OD, FAAO

GHc–scw eye care Providers

GHc–scw doMestic violence intervention ProGraM

GHc–scw occuPational tHeraPy Providers

Jacquelyn Finley,OTR, CHT, CSHE

Diane Harlowe,MS, OTR, FAOTA

Ellen Martin,OTR

Nissa McWilliams,OTR

Kaitlin Rooney,MS, OTR


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Steven Crade,PT

Gina Droessler,LPTA, CSCI, CPI

Ted German,DPT, CIMT, CPRS

Judy Pellerin–Goll,PT

Jacqueline Kimble,PT, Cert MDT,

CSCS

Kate Latorraca,PT

Pranali Mhadolkar,MPT

Brenda Milbrath,MS, PT, OCS, CIMT

Wendy Parsons,MPT

Dan Russo,MPT, LMT

Marcy Schulz,DPT, SCS, ATC

Scott Theado,PT, CSCS

Rama Ahuha,MPT

Barb Urmann,MOMT, PT

Matt Brown,DPT

Jaime Reich,DPT

GHc–scw Podiatry Providers

William Chubb, DPM, FACFAS

Stephen Bogue,DPM

Stephen Merckx,DPM

29

CAPITOL CLINIC675 West Washington Ave.

Madison, WI 53703

EAST CLINIC5249 East Terrace Dr.Madison, WI 53718

HATCHERY HILL CLINIC3051 Cahill Main

Fitchburg, WI 53711

SAUK TRAILS CLINIC8202 Excelsior Dr.

Madison, WI 53717

*Services provided within a GHC–SCW Clinic by a GHC–SCW Complementary Medicine Provider are limited to the GHC–SCW member benefit as outlined in the Benefits Summary and Member Certificate.

GHc–scw coMPleMentary Medicine locationscall (608) 662-5090

Get a massage, relax with yoga, or experience any of our Complementary Medicine Services* (see page 30). ComplementaryMedicineisforanyone!

We focus on “building blocks for health,” such as prevention and addressing the underlying causes of a disease, rather than simply treating the external symptoms. We teach people to alter their responses to the stresses of daily life through self–care, a healthy diet and various manual and energy therapies.

Visit ghcscw.com and click on “Complementary Medicine” to learn more.

GHc–scw coMPleMentary Medicinecall (608) 662–5090 for an appointment

(or schedule through your GHCMyChartSM account)

massage...pilates...yoga...


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es GHc–scw coMPleMentary Medicine services & classescall (608) 662–5090 for an appointment.

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning.This is done by inserting needles and applying heat or electrical stimulation at very precise acupuncture points.

CranioSacral Therapy is a very gentle hands–on bodywork technique that brings about equilibrium to the craniosacral system.

The Feldenkrais Method is for anyone who wants to reconnect with their natural abilities to move, think and feel. Whether you want to be more comfortable sitting at your computer, or playing with your children and grandchildren, these gentle lessons may improve your overall well–being.

Lymph Drainage Therapy involves the stimulation of the lymphatic vessels by employing specialized massage therapy techniques. Stimulation of the lymphatic vessels by massage helps to remove toxins, metabolic waste products, disease–causing agents and extra lymph fluid.

Massage Therapy encompasses many different techniques. In general, therapists press, rub and otherwise manipulate the muscles and other soft tissues of the body. They most often use their hands and fingers, but may use their forearms, elbows or feet.

Mind/Body Therapy helps individuals process where and how emotions are held in the body. It may relieve headaches, chronic pain and emotional trauma.

Mindfulness Meditation techniques include specific postures, focused attention or an open attitude toward distractions, such as focusing attention or maintaining a specific posture. This helps to suspend the stream of thoughts and relax the body and mind, which increases calmness and relaxation, and improve psychological balance.

Naturopathic Medicine is a natural approach to wellness, that teaches diet, exercise and lifestyle changes along with cutting edge natural therapies to enhance the bodies’ ability to ward off and combat disease.

Personal Fitness involves working one–on–one with an instructor in private sessions to create a custom fitness or yoga program tailored to your needs and abilities.

Pilates is a method of exercise, which aims to encourage the use of the mind to develop core postural muscle strength, stability and flexibility, resulting in more efficient and graceful movement.

Reflexology includes pressure to areas on the foot that correspond to the affected organs, which may help to relieve symptoms such as pain.

Reiki is a form of meditation for stress reduction and relaxation that also promotes healing.

Self as Source is a cognitive behavior training using both mind awareness and body awareness. It is a set of learnable skills to harness power so that you can be in charge of your life experience.

Tai Chi is a martial art that combines breath with action, which may increase flexibility, strengthen the body, restore balance and generate peace of mind.

Thai Massage (or Thai yoga massage), involves the therapist using his or her hands, knees, legs and feet to move you into a series of yoga–like stretches. Thai massage is like doing yoga without any work.

Yoga, used for health purposes, typically combines physical postures, breathing techniques and meditation or relaxation. It is used as part of a general health regimen and for a variety of health conditions.

Zero Balance is a powerful body/mind therapy that uses skilled touch to address the relationship between energy and structures of the body. The therapist uses finger pressure and gentle traction on areas of tension in the body.

Zumba is a dance fitness program that combines Latin and international music with an effective workout system, in an effort to make exercise fun.


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feldenkrais

MassaGe tHeraPy

infant MassaGe lyMPH drainaGe tHeraPy

GHc–scw coMPleMentary Medicine Providers

Amy Crikelair,LAC, MAC, CA

Kathi Drake,RN, BSN, MSOM

Richard Oberg,MSOM

Xuehui Wang,MSOM

Patricia Smith Khadija Zayed,CMT, RMT

Cyndi Fine,CMT

Linda Alanen,CMT, RN


Miranda Mueller,CMT

Miranda Mueller,CMT

Photo not available:Denise Duranczyk,GCFP

Patricia Smith

Deborah Clark,CMT

Alisha Cook,CMT

Jonathan Garber,CMT

Wendy Grapentine,CMT

Elizabeth Hanson,CMT

Mary Karls,CMT

Gabrielle Laden,LMT

Candice Lewis,LMT

Miranda Mueller,CMT

Julie McNeil,CMT

Steve Nack,CMT

Sam Riddle,CMT


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John Santiago,CMT

Jon Schwier,CMT

Kimberly Suoja,CMT

MassaGe tHeraPy cont’d

self as source

yoGa zero balance

zuMbatai cHi tHai MassaGe

Mind/body tHeraPy

Personal fitness

reiki

Pilates reflexoloGy

Mindfulness Meditation

naturoPatHic Medicine

Sara Bartlett

Bonnie Milgrim,MA, CPC

Michael Smith (MH), EdS

Michael Smith (MH), EdS

Terri Pellitteri Ghadeer Alafifi Faith Dey

Faith DeyFNU Ruddy,ND

Katy Wallace,ND

Mary Karls,CMT

Mary Karls,CMT

Deborah Clark,CMT

Miranda Mueller,CMT

Khadija Zayed,CMT, RMT

Jonathan Garber,CMT

Natilie Buster Maruti Landau Amber ThompsonFaith Dey

Wendy Grapentine, CMT

Gabrielle Laden,LMT

Gabrielle Laden,LMT



Julie McNeil,CMT


seei

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GH

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wseeinG a sPecialist outside of GHc–scw See your Benefits Summary and Member Certificate for full details on services requiring prior authorization.

When you see your Primary Care Provider (PCP), he or she may need a Specialist opinion regarding your care. Planned Specialty visits outside of the GHC–SCW Primary Care Networks require coordination by your PCP. Members must receive an approval letter from the GHC–SCW Care Management Department before receiving these services.

IfyoumakeanappointmentwithoutanapprovalletterfromGHC–SCWCareManagement,youmayberesponsibleforfullpaymentoftheservicesprovided.

1. referral reQuest • ThereferralrequestbeginswhenyouvisityourPCPand a decision is made to refer you to a specific Specialist. • AnorderisplacedinyourElectronicMedicalRecord(EMR), which sends a message to the Care Management Department. Care Management staff will evaluate the order to determine if it is a covered benefit and review it against national care guidelines for whether the care is medically necessary. • Mostreferraldecisionsoccurwithin4–5businessdays. Up to 15 days are allowed for review if additional information is needed by the Care Management staff and/or the Medical Director or Physician Reviewer.

2. aPProval letter • AnapprovalletterwillbemailedtoyouandtheSpecialist when Care Management approves the referral request. At that point, you may schedule an appointment to see the Specialist. • Youmaywishtotakeyourapprovallettertoyourappointment, as it is not always seen in the Specialty EMR.

Approval does not guarantee benefits: GHC–SCW approves services or supplies based on the information that is available at the time of the approval/denial decision. Approval does not guarantee a member’s eligibility or benefits under his or her health plan. It is the responsibility of the member to know their Deductible, Co–pay or Co–insurance amounts that apply to Specialty services.

Denied requests:You will receive a denial letter in the mail explaining the reason for the denial and your member appeal rights. If your appointment has already been scheduled for the same day or next day after the denial decision is made, GHC–SCW Care Management staff will notify you of the denial decision.

PriMary care Provider

sPecialty care Provider


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Grid sPecialty care network Grid – all networks

find your network–tHen refer to tHe cHart to see wHere you Go for needed care.

allerGy/astHMaUW Health – 20 South Park20 S. Park St., Madison (608) 287–2600UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–1280UW Health – West Clinic451 Junction Rd., Madison (608) 263–6180Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824-4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie (608) 825–3008

cardiovascularUW Health – 202 South Park202 S. Park St., Atrium 3, Madison (608) 417–5970UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 263–1530UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–1530

UW Health – West Clinic451 Junction Rd., Madison (608) 263–1530

GHc uwfM uwcG uws acHc wfMc

GHC = GHC–SCW Clinic NetworkUWFM = UW Health–Family Medicine Network UWCG = UW Health–Cottage Grove Network UWS = UW Health–Stoughton Network

ACHC = Access Community Health Center Network WFMC = Access–Wingra Family Medical Center Network

= Approved Network Location



sPec

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GridsPecialty care network Grid – all networks

find your network–tHen refer to tHe cHart to see wHere you Go for needed care.

cardiovascular (cont’d)Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie (608) 825–3008

cHiroPractic careGHC–SCW – Capitol Clinic675 W. Washington Ave., Madison (608) 257–9700GHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 222–9777GHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg(608) 661–7200GHC–SCW Sauk Trails Clinic8202 Excelsior Dr., Madison (608) 831–1766LSM ChiroMedicine Clinic, S.C.185 W. Netherwood Rd., Oregon (608) 835–8635

clinical HealtH educationGHC–SCW – Capitol Clinic675 W. Washington Ave., Madison (608) 257–9700GHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 222–9777GHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 661–7200GHC–SCW – Sauk Trails Clinic8202 Excelsior Dr., Madison (608) 831–1766

GHc uwfM uwcG uws acHc wfMc



= Approved Network Location



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coMPleMentary MedicineGHC–SCW – Capitol Clinic675 W. Washington Ave., Madison (608) 662–5090GHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 662–5090GHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 662–5090GHC–SCW – Sauk Trails Clinic8202 Excelsior Dr., Madison (608) 662–5090

dental servicesDental Health Associates – East Clinic49 N. Walbridge Ave., Madison (608) 246–2555Orthodontics: (608) 246–3691Dental Health Associates7001 Old Sauk Rd., Madison (608) 833–2578Dental Health Associates7017 Old Sauk Rd., Madison (608) 833–1889Dental Health Associates – South2971 Chapel Valley Rd., Madison (608) 661–6400

derMatoloGyGHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 661–7200UW Health – 1 South Park1 S. Park St., Madison (608) 287–2450 UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–1288

sPecialty care network Grid – all networksfind your network–tHen refer to tHe cHart to see wHere you Go for needed care.

GHc uwfM uwcG uws acHc wfMc = Approved Network Location





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Grid

derMatoloGy (cont’d)UW Health – West Clinic 451 Junction Rd., Madison1st Floor: (608) 265–7670Lower Level: (608) 265–0700MOHS/Dermatologic Surgery: (608) 263–6226Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000

ear, nose & tHroatUW Health – 1 South Park1 S. Park St., Madison (608) 287–2500UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 265–7760UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–6190Michael McDonald, MDOtolaryngology & Facial Plastic Surgery3209 Dryden Dr., Madison (608) 241–6661Dean Stoughton Clinic225 Church St., Stoughton (608) 877–2777

Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie (608) 825–3008

Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000







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endocrinoloGy/diabetesGHC–SCW – Capitol Clinic 675 W. Washington Ave., Madison (608) 257–9700 Diabetes OnlyUW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–7406(608) 890–6526 PediatricsUW Health – West Clinic451 Junction Rd., MadisonDiabetes: (608) 263–7741Endocrinology: (608) 263–5010Pediatrics: (608) 263–6420Dean Clinic1313 Fish Hatchery Rd., Madison (608) 252–8000

eye careGHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 257–7328

GastroenteroloGyUW Health – 20 South Park20 S. Park St., Madison (608) 287–2680UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–6960







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GastroenteroloGy (cont’d)UW Health – West Clinic451 Junction Rd., Madison (608) 265–8528Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000

General surGeryUW Health – 1 South Park1 S. Park St., Madison (608) 287–2100 UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–6969UW Health – UW Hospital & Clinics 600 Highland Ave., Madison (608) 263–7502(608) 266–6400 Breast CenterDean Stoughton Clinic225 Church St., Stoughton (608) 877–2777Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie(608) 825–3008







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HeMatoloGyUW – Carbone Cancer Center600 Highland Ave., Madison (608) 265–1700UW – Carbone Cancer Clinic1 S. Park St., Madison (608) 287–2552

infertilityWisconsin Fertility Institute3146 Deming Way, Middleton (608) 824–0075Generations Fertility Care2365 Deming Way, Middleton (608) 824–6160

Mental HealtH and substance use disorderautisMWisconsin Early Autism Project, Inc.6402 Odana Rd., Madison (608) 288–9040Integrated Development Services, Inc.6506 Schroeder Rd., Madison (608) 441–0123Achieving Collaborative TreatmentP.O. Box 259691, Madison (608) 443–7032

beHavioral HealtHGHC–SCW – Capitol Regent Behavioral Health Center 700 Regent St., Madison (608) 441–3290GHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 441–3970GHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 661–7200GHC–SCW – Sauk Trails Clinic8202 Excelsior Dr., Madison (608) 831–1766

substance use disorderUW Health – Gateway Recovery25 Kessel Court, Suite 200, Madison (608) 278–8200







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nePHroloGyUW Health – 20 South Park20 S. Park St., Madison (608) 287–2045UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – Kidney Clinic3034 Fish Hatchery Rd., Madison (608) 270–5656Wisconsin Dialysis – East Clinic4600 American Parkway, Madison (608) 243–3003Wisconsin Dialysis – Fitchburg Clinic3034 Fish Hatchery Rd., Madison (608) 270–5600

neuroloGyUW Health – 20 South Park20 S. Park St., Madison (608) 287–2090UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 263–9550UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–5442(608) 890–6500 Pediatrics Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean Stoughton Clinic225 Church St., Stoughton (608) 877–2777







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obstetrics & GynecoloGyUW Health – 20 South Park20 S. Park St., Madison (608) 287–2830UW Health East Clinic5249 E. Terrace Dr., Madison (608) 265–1230UW Health – East Towne4122 East Towne Blvd., Madison (608) 242–6840UW Health – Fitchburg Clinic5543 E. Cheryl Pkwy., Fitchburg (608) 274–5300UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–6240 Gynecology OnlyUW Health – West Clinic451 Junction Rd., Madison (608) 265–7601UW Health – West Towne7102 Mineral Point Rd., Madison (608) 828–7610Meriter De Forest–Windsor ClinicUW Health Obstetrics & Gynecology4200 Savannah Dr., DeForest(608) 417–3300Meriter Monona Clinic–UW Health Obstetrics & Gynecology6408 Copps Ave., Monona (608) 417–3000Meriter Woman Care Clinic 20 S. Park St., Madison (608) 417–5433 Gynecology OnlyDean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie(608) 825–3008







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occuPational tHeraPyGHC–SCW – Capitol Clinic675 W. Washington Ave., Madison (608) 257–9700GHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 222–9777GHC–SCW – Princeton Club West PT/OT Clinic8054 Watts Rd., Madison (608) 662–5060Stoughton Hospital2300 US Highway 51–138, Stoughton (608) 873–2292

oncoloGyUW – Carbone Cancer Clinic1 S. Park St., Madison (608) 287–2552UW – Carbone Cancer Center600 Highland Ave., Madison (608) 265–1700Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean Stoughton Clinic225 Church St., Stoughton (608) 877–2777

oPHtHalMoloGyUW Health – Deming Way2349 Deming Way, Middleton (608) 824–3937UW Health – East Eye Clinic5249 E. Terrace Dr., Madison (608) 265–1270UW Health – Madison Eye Associates780 Regent St., Madison (608) 257–4286UW Health – University Station 2880 University Ave., Madison Adults: (608) 263–7171 Pediatrics: (608) 263–6414Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000







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oPHtHalMoloGy (cont’d)Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie (608) 825–3008Dean Stoughton Clinic225 Church St., Stoughton (608) 877–2777

oral surGeryCenter For Oral and Maxillofacial Surgery, S.C.20 S. Park St., Madison (608) 256–1961Center For Oral and Maxillofacial Surgery, S.C. 7007 Old Sauk Rd., Madison (608) 819-8760Center For Oral and Maxillofacial Surgery, S.C. 5302 Buttonwood Dr., Madison (608) 240–0863

ortHoPedicsUW Health – 1 S. Park1 S. Park St., Madison (608) 287–2700UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – Research Park621 Science Dr., Madison(608) 263–8850UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–7540







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ortHoPedics (cont’d)Orthopedic Associates, Ltd.1520 Vernon St., Stoughton (608) 873–4100Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie (608) 825–3008Dean Stoughton Clinic225 Church St., Stoughton (608) 877–2777

Pain ManaGeMentUW Health – East Clinic5249 E. Terrace Dr., Madison (608) 263–9550UW Health – Research Park Clinic621 Science Dr., Madison (608) 263–9638

PHysical Medicine and reHabilitationUW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–1250UW Health – Rehabilitation Clinic6630 University Ave., Middleton (608) 263–6540UW Health – Research Park621 Science Dr., Madison (608) 265–3207







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PHysical tHeraPyGHC–SCW – Capitol Clinic675 W. Washington Ave., Madison (608) 257–9700GHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 222–9777GHC–SCW – Princeton Club West PT/OT Clinic8054 Watts Rd., Madison (608) 662–5060Stoughton Hospital – Rehab & Sports Medicine Clinic at the Stoughton Wellness & Athletic Center 2300 US Highway 51–138Stoughton (608) 873–2292

Plastic surGeryUW Health – 1 South Park1 S. Park St., Madison (608) 287–2500 / (608) 287–2100UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–7502Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000

PodiatryGHC–SCW – East Clinic5249 E. Terrace Dr., Madison (608) 222–9777GHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 661–7200GHC–SCW – Sauk Trails Clinic8202 Excelsior Dr., Madison (608) 831–1766







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PulMonary MedicineUW Health – 202 S. Park202 S. Park St., Madison (608) 417–5950UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–7203Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Sun Prairie Clinic10 Tower Dr., Sun Prairie (608) 825–3008Dean Stoughton Clinic225 Church St., Stoughton (608) 877–2777

radiation oncoloGyUW Health – East Clinic5249 E. Terrace Dr., Madison (608) 263–8500UW Health – Carbone Cancer Center600 Highland Ave., Madison (608) 263–8500Turville Bay MRI & Radiation Oncology Center1104 John Nolen Dr., Madison Radiation Oncology: (608) 251–6868MRI: (608) 258–7820







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radioloGy/iMaGinGGHC–SCW – Hatchery Hill Clinic3051 Cahill Main, Fitchburg (608) 661–7200UW Health – 1 S. Park1 S. Park St., Madison (608) 287–2050UW Health – 202 S. Park202 S. Park St., Madison (608) 417–6090UW Health – Research Park621 Science Dr., Madison (608) 265–8333UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–8340Stoughton Hospital Medical Imaging900 Ridge St., Stoughton (608) 873–2299Turville Bay MRI and Radiation – Oncology Center1102 John Nolen Dr., Madison (608) 258–7820

rHeuMatoloGyUW Health – 1 S. Park1 S. Park St., Madison (608) 287–2800UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison(608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–1280UW Health – West Clinic451 Junction Rd., Madison (608) 263–7577Dean Clinic1313 Fish Hatchery Rd., Madison (608) 252–8000

sleeP disorders Wisconsin Sleep6001 Research Park Blvd., Madison (608) 232–3333







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tHoracic surGery UW Health – UW Hospital & Clinics600 Highland Ave., Madison Thoracic: (608) 263–7502Cardiac: (608) 263–1530UW Health – 202 S. Park202 S. Park St., Madison (608) 263–0439Dean Clinic – Outpatient Surgery700 S. Park St., Madison (608) 259–3500

uroloGyUW Health – 1 S. Park1 S. Park St., Madison (608) 287–2900UW Health – American Family Children’s Hospital – Pediatrics1675 Highland Ave., Madison (608) 263–6420UW Health – East Clinic5249 E. Terrace Dr., Madison (608) 265–6966UW Health – UW Hospital & Clinics600 Highland Ave., Madison (608) 263–4757UW Health – West Clinic451 Junction Rd., Madison (608) 263–4757Dean Clinic1313 Fish Hatchery Rd., Madison(608) 252–8000Dean East Clinic1821 S. Stoughton Rd., Madison(608) 260–6000Dean West Clinic752 N. High Point Rd., Madison(608) 824–4000Dean Stoughton Clinic225 Church St., Stoughton(608) 877–2777






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MyChart® is a registered trademark of Epic Systems Corporation. KidsChart® is a registered trademark of Group Health Cooperative of South Central Wisconsin (GHC–SCW). MyKidsChartSM, GHCKidsChartSM and GHCMyChartSM are service marks of Group Health Cooperative of South Central Wisconsin (GHC–SCW). Healthwise® and Healthwise® Knowledgebase are registered trademarks of Healthwise, Inc.

GHCMyCHARTSM

just got smarterintroducinG webMd HealtH ManaGer – exclusive to GHc-scw MeMbers.

The interactive, private and personalized wellness web portal that’s uniquely you.

GHCMyCHARTSM

GHC-SCW partnered with WebMD® – to offer you the WebMD Health Manager. Start reaching your goals – on your own terms – with a variety of features to support you:

• HealthQuotient™, a detailed and personalized report that identifies your personal health risks • Aninteractivedigitalhealthcoach • Self–pacedhealthtrackers,calculators and other online tools • Andmore!

witH GHCMyCHARTSM Schedule appointments online* Refill medications Securely message with staff* View select test results* Print immunization records Access insurance benefit information View your Health Summary, medications, allergies, immunizations and more*

*Available to members who receive care at GHC-SCW Clinics (Capitol, DeForest, East, Hatchery Hill, and Sauk Trails).

siGn uP today! see next page for details Orvisitghcscw.comandclickon“AboutGHCMyChart”tolearnmore.

Sign in to your GHCMyChartSM account to get started orvisit ghcscw.com and click on to learn more.

aVaILaBLeFaLL 2012

Parents:GHCMyChartSM may allow you to access certain information of your child’s medical and insurance records

(Age restrictions may apply).


First Name Last Name

GHC–SCW Member Number Primary Care Provider

E–Mail Address (A message will be sent to this e–mail address to let you know when new information has been posted to your personal GHCMyChartSM account.)

Signature Date

How to reQuest aGHCMyCHARTSM accountVisit ghcscw.com to request activation or tear off the attached registration form, sign and return to GHC–SCW. Members may also set up an account in person at any GHC–SCW reception desk, complete the form online from ghcscw.com or call (608) 828–4853 to request that a form be mailed to their home. Once GHC–SCW receives a signed consent form or an online submitted application, an activation code will be mailed to the individual’s home within 7 to 10 days. The individual then has 90 days to activate his or her account before the activation code expires.

eliGibilityGHCMyChartSM is offered to members ages 18 and older. Services available through GHCMyChartSM vary depending on Provider network. Members who receive primary care at a GHC–SCW Clinic will have a more expansive list of online tools available than members who receive Primary Care at a non–GHC–SCW Clinic. This is due to the use of an integrated electronic medical records system throughout GHC–SCW Clinics.

contact us to learn MoreVisit ghcscw.com to learn more about this convenient online service. Please call the GHC–SCW Members Services Department at (608) 828–4853 with any questions or concerns regarding GHCMyChartSM. Member Services staff are available 8 a.m. – 5 p.m., Monday through Friday.

MyChart® is a registered trademark of Epic Systems Corporation. KidsChart® is a registered trademark of Group Health Cooperative of South Central Wisconsin (GHC–SCW). MyKidsChartSM, GHCKidsChartSM and GHCMyChartSM are service marks of Group Health Cooperative of South Central Wisconsin (GHC–SCW). Healthwise® and Healthwise® Knowledgebase are registered trademarks of Healthwise, Inc.

siGn Me uP for GHCMyChartSM (All fields required)

Please clip and mail or fax to GHC–SCW

siGn Me uP for GHCMyCHARTSM

If you are covered by a Group Health Cooperative of South Central Wisconsin insurance plan and are age 18 or older, we invite you to register for a GHCMyChartSM account.InstructionsStep 1: Register online at ghcscw.com.

OR Complete, sign and return this form to GHC–SCW. Mail form to: Group Health Cooperative of South Central Wisconsin Attention: GHCMyChart P.O. Box 44971, Madison, WI 53744

Copy and fax form to: Group Health Cooperative of South Central Wisconsin Attention: GHCMyChart (608) 441–3499

Step 2: Within 7–10 days, GHC–SCW will mail a secure activation code to your home address, or go online to request an activation code.

Step 3: Use the code to complete a simple online activation process.

Step 4: Log in to review and acknowledge the GHCMyChartSM Terms & Conditions.

Step 5: Begin using GHCMyChartSM!

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to obtain your reiMburseMent, Please coMPlete tHe followinG stePs:

1. siGn uP for tHe ProGraMSign up online by filling out the Wellness Reimbursement Form online at ghcscw.com or request a paper form by calling GHC–SCW Marketing Department at (608) 662-4193, visit a GHC–SCW clinic location or check with your workout facility. Complete the form with your name, GHC–SCW member number, date of birth, address, and phone number. This information must be included on the form to be eligible for reimbursement.

2. subMit Proof of ParticiPation•Exercise for Excellence: Complete the Exercise for Excellence Tracking Form or a print out from your fitness facility with 120 documented workouts (one workout per day within a calendar year).•Community Supported Agriculture (CSA): Proof of purchase from participating farm.•Weight Watchers or Jenny Craig: Proof of purchase valuing more than $100.•Community Classes at UW Health, St. Mary’s, Meriter and MSCR: Signature from program coordinator.•Doula Services – An individual must first visit with the GHC–SCW Prenatal Coordinator. During the visit the Prenatal Coordinator will review Doulas in the Dane County area available to you. Once you have chosen a Doula, you must complete

all sessions. The next step will be to complete your reimbursement by printing and filling out the Wellness Reimbursement Form. Also collect a signature from your Doula instructor verifying that you have completed the sessions.• Athletic Shoe Reimbursement – Members may purchase a pair of athletic shoes at a discounted rate at one of the participating retailers. Members will need to submit proof of purchase along with completed Wellness Reimbursement Form to receive an additional $25 reimbursement.

3. send tHe coMPleted wellness reiMburseMent forM, exercise for excellence trackinG forM (if aPPlicable) and Proof of PurcHase to:GHC–SCW Marketing DepartmentAttn. Wellness ReimbursementP.O. BOX 44971Madison, WI 53744–4971

For each calendar year, the deadline for reimbursement submission is January 30 of the following calendar year. Please allow 45 days for your reimbursement request to be processed.

How do i receive My reiMburseMent?

for More inforMation, Please visit tHe web at GHcscw.coM

Wellness Reimbursement wHat is tHe GHc–scw wellness reiMburseMent ProGraM?GHC–SCW members may choose to participate in one of the programs listed below. A request for reimbursement may be submitted one time throughout the year, after program criteria is met. GHC–SCW will reimburse you either $100 (individual) or $200 (family of two or more enrolled members) for the year. The deadline for reimbursement submission is January 30 of each calendar year.Members submitting for reimbursement must have GHC–SCWinsurance as their primary coverage. Members with Medicare astheir primary coverage and GHC–SCW as their secondary coverage are also eligible for reimbursement.

MeMbers May cHoose froM any of tHe followinG services:•ExerciseforExcellence•CommunitySupportedAgriculture(CSA)(Madison Area Community Supported Agriculture Coalition (MACSAC), FRESH Food Connection, FH King CSA, Farley Center Small Farms, Simply Wisconsin)•WeightWatchers•JennyCraig•CommunityClassesatUWHealth,St.Mary’s, Meriter and MSCR•DoulaServices•AthleticShoeReimbursement


Glos

sary

.

How do i receive My reiMburseMent?

for More inforMation, Please visit tHe web at GHcscw.coM

Care Management assists members with complex care management and provides help with transitioning of care among various health care providers. This department is also responsible for processing, approving and denying Prior Authorization requests.

Care Teams include Primary Care Providers (Physicians, Physician Assistants or Nurse Practitioners), RN Coordinators and Case Managers. The team works together to support each other and you – the member. A Care Team integrates the skills of all health care staff with those of the patients and family into a comprehensive patient care program.

Case Managers assist PCPs in coordinating medical care. If you have a complex medical situation or are facing an inpatient visit, you might work with a Case Manager. The Case Manager coordinates the care and services needed during hospitalization, works with Providers to develop a plan of care to meet your needs, answers your questions and helps you with any discharge needs. If needed, they will help with referrals to community agencies, for example, counseling services. They will also help with complex financial issues and provide support to patients and families as requested.

Clinical Health Education (CHE) helps you learn about your health and how to prevent or manage chronic conditions. CHE Providers may help you create an individualized plan to improve your health, based on credible and easy–to–understand health information.

Complementary Medicine includes many forms of treatments and therapies that are not considered part of conventional medicine. Complementary Medicine focuses on “building blocks for health” such as prevention and addressing the underlying causes of a disease, rather than simply treating the external symptoms.

The goal of Complex Care Management (CCM) is to assist members with multiple, complex or acute life – threatening conditions to obtain access to quality care and appropriate services. The Case Manager will assist the member with goals, specialty referrals and their

self–management care plan. Members are accepted into Complex Care Management by meeting certain enrollment criteria.

Emergency Care is care for a life–threatening medical condition that includes severe symptoms, which could cause serious jeopardy to a person’s health.

Family Medicine involves broad training and may include expertise in the areas of obstetrics and gynecology, pediatrics or internal medicine. Family Medicine concentrates on health care for the entire family, with an emphasis on continuity of care for all ages. Family Medicine Providers are ideal for members who have families or anticipate having children.

A formulary is a list of covered prescription drugs under a benefits plan. They have been proven to be safe, effective and cost–efficient. As a member of GHC–SCW, your prescription drug coverage includes only the drugs listed on the GHC–SCW formulary, except in certain cases of medical necessity.

Internal Medicine specializes in adult medicine and complex health care. The focus is on the interrelated systems of the body and how they are affected by illness. Older adults often prefer Internal Medicine Providers for this reason. An Internal Medicine Provider may be a good choice if you or your family members are over the age of 16.

In–Plan Primary and Specialty Care is provided by a panel of Providers under contract with GHC–SCW. Prior Authorizations for specialty care are limited to this panel of contracted Providers. Specialty medical care provided by a contracted non–GHC–SCW Provider is not covered if the service requested may be provided by a GHC–SCW Specialty Provider.

A member is a person who is enrolled with GHC–SCW as either a subscriber or a dependent of a subscriber.

A network may be considered a “path” through the health care system. GHC–SCW offers six distinct networks for Primary and Specialty Care. Benefits

Glossary The following explanations are intended to help guide you. These are not definitions. For definitions, refer to your Member Certificate.


Glos

sary

coverage is only provided to members who stay within their chosen network.

Pediatrics focuses on the special health conditions of childhood and adolescence, as well as a wide range of preventive services. A Pediatrician will coordinate the necessary health screenings and immunizations to help your child get on the path to a healthy future. Children age 17 or younger often see a Pediatrician to coordinate their Primary Care.

A Certified Physician Assistant (PA–C) and an Advanced Practice Nurse Prescriber (APNP) are qualified, licensed health care professionals with extensive academic training and clinical experience. They provide a range of services such as routine physical examinations, evaluation and management of common medical problems and clinical health education. Like the GHC–SCW Primary Care Physicians, PA–C and NP are certified and committed to personalized comprehensive health care for you and your family.

Primary Care (PC) is the first point of contact for the member within the health care system. It includes a broad spectrum of health care services and preventive care. The aim of Primary Care is to provide a foundation for good health care and to coordinate the care that the patient receives.

A Primary Care Provider (PCP) is a health care Provider who provides Primary Care to the member. The PCP also helps to provide continuity of care, and to coordinate services, if necessary, with recommended Specialty Care Providers. A PCP may be a Family Medicine Physician, an Internal Medicine Physician, a Pediatrician, a Physician Assistant or a Nurse Practitioner.

Prior Authorization is the process of approving Specialty Care services when needed, based on

appropriateness of care and location, by the Care Management Department, before an appointment is scheduled.A referral is the first step in the Prior Authorization process. The PCP is responsible for issuing standard medical referrals and notifying the GHC–SCW Care Management Department for review and approval (see Prior Authorization).

A Registered Nurse (RN) is a professional nurse who has completed a course of study at an approved and accredited school of nursing and who has passed the National Council of Licensure Examination. RNs are licensed to practice by individual states.

Specialty Care is care for a specific condition, or care to provide diagnosis and treatment by a Provider with training in a particular field of medicine.

A Specialty Care Provider is an individual, team or facility who provides Specialty Care to the member. Specialty Care Providers specialize in one or more field of medicine and have developed advanced skills in that area.

Urgent Care is same–day or after–hours care for conditions that require immediate attention, non–life threatening conditions, or persistent or unusual discomfort associated with an illness. Some examples of Urgent Care include colds and flu, migraine headaches and simple bone fractures (not piercing the skin).

Glossary (cont’d) The following explanations are intended to help guide you. These are not definitions. For definitions, refer to your Member Certificate.

MK12-78-0(8/12)PD

introducing your GHcnurseconnect teamYour 24-hour Nurse Advice Line

GHcnurseconnect team(608) 661–7350 local or (855) 661–7350 toll-free

coMinGJanuary 2013!exaMPles of wHen to call:

• Generalcareadvice&triage• Ifyou’reunsureifyouneed an appointment• Cough,cold,fever,flu,sorethroat• Possiblebrokenbones,sprains, urinary tract infections and head injuries• Otherhealth-relatedissues

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 BetterTogether.

Please clip and keep as a quick reference.

need Medical care and not sure wHat to do?Callour24-hournurseadviceline:

GHc–scw PriMary care clinicsCapitol Clinic(608) 257–9700675 W. Washington Ave., Madison 53703 Mon., Wed., Fri., 8 a.m. – 5 p.m.Tues., Thurs., 8 a.m. – 7 p.m.

DeForest Clinic(608) 846–4787815 S. Main St., DeForest 53532 Mon. – Fri., 8 a.m. – 4:30 p.m.

East Clinic(608) 222–97775249 E. Terrace Dr.Madison 53718 Mon., 9 a.m. – 7 p.m.Tues. – Fri., 8 a.m. – 5 p.m.

Hatchery Hill Clinic(608) 661–72003051 Cahill MainFitchburg 53711 Mon., Wed. – Fri. 8 a.m. – 5 p.m.Tues., 8 a.m. – 7 p.m.

Sauk Trails Clinic(608) 831–17668202 Excelsior Dr., Madison 53717 Mon., 8 a.m. – 7 p.m.Tues. – Fri., 8 a.m. – 5 p.m.

uw–HealtH – cottaGe Grove clinicCottage Grove Clinic(608) 839–3104500 Westlawn Dr., Cottage Grove 53527 Mon. – Fri., 8 a.m. – 5 p.m.

uw HealtH – faMily Medicine clinicsBelleville Clinic(608) 424–33841121 Bell West Blvd, Belleville 53508Mon. – Fri., 8 a.m. – 5 p.m.

Northeast Clinic(608) 241–90203209 Dryden Dr., Madison 53704Mon. – Fri., 8 a.m. – 5:30 p.m.

Verona Clinic(608) 845–9531100 N. Nine Mound Rd., Verona 53593Mon. – Fri., 8 a.m. – 5 p.m.

uw HealtH – stouGHton clinicStoughton Clinic(608) 877–26601001 Nygaard St.Stoughton 53589Mon. – Fri., 8 a.m. – 5 p.m.

access coMMunity HealtH centersSouth Side Clinic(608) 443–54802202 S. Park St., Madison 53713Mon. – Fri., 8 a.m. – 5 p.m.

William T. Evjue Clinic(608) 443–54803434 E. Washington Ave.Madison 53704Mon. – Fri., 8 a.m. – 5 p.m.

access–winGra faMily Medical centerAccess–Wingra Family Medical Center(608) 263–3111701 Dane St., Madison 53713Mon. – Fri., 8:30 a.m. – 5 p.m.

GHc–scw urGent care clinicWhen you need medical care, your first line of defense should be to call your Primary Care Clinic for an appointment during business hours (see below). If after hours, call the GHC–SCW Urgent Care Clinic.

(608) 257–9700675 West Washington Ave., Madison, WI 53703Monday – Friday, 8 a.m. – 9 p.m. & Saturday – Sunday, 9 a.m. – 9 p.m.

coMinG January 2013!• Getgeneralcareadviceandtriage• Haveyourconcernsaddressedoverthephone• SaveatriptotheEmergencyRoom• Getinformationyouneedwhenyouneedit

GHcnurseconnectLocalnurses,caringforyou24/7.

1(855) 661–7350 or (608) 661–7350

Group Health Cooperative of South Central Wisconsin (GHC–SCW)