Sumter Regional Hospital

SGHA Physician Listing

Allied Health Practitioners

Plan Design Summary

Claims & Eligibility Information

Pre-Cert Requirements

Laboratory Instructions

Tertiary Referrals

Physician Listing

Primary Care Physicians Internal Medicine Pediatrics Allergy &Immunology Anesthesiologist Dermatology Ear Nose & Throat (ENT) Emergency Medicine Endocrinology Gastroenterology /Internal Medicine General Surgery Gynecology /Gynecologic Oncology Nephrology /Internal Medicine Neurology Obstetrics and Gynecology Ophthalmology Optometry Orthopedic Surgery Pathology Podiatry Psychiatry Radiology Urology

Primary Care Physicians

Michael S. Busman

Audrey M. Hodge

Michael P. Raines

Internal Medicine

Fleming Burroughs

James G. Herron

Richard T. Oster

Frank H. Parrott

Cindy L. Phillips

Frank A. Wilson IV

K. Narasimha Reddy

Jamie Steinsapir

Pediatrics

Andrew C. Carlson

Judy Y. Y. Cheng

Nelson T. Madrazo

Allergy & Immunology

Dennis A. Robinson

Anesthesiologist

Judy G. Johnson

Dermatology

William G. Irwin

Ear, Nose & Throat (ENT)

Geoffrey W. Scott

Emergency Medicine

Ben C. Andrews Jr.

Linda K. Hudson

Charles R. Sheffield

Endocrinology

Jamie Steinsapir

Gastroenterology /Internal Medicine

General Surgery

Douglas R. Joyner

Harvey L. Simpson

Glenn E. Summers

Gynecology /Gynecologic Oncology

A. Gatewood Dudley

Nephrology / Internal Medicine

K. Narasimha Reddy

Neurology

Shijun (James) Pan

Obstetrics and Gynecology

Michael L. Cacciatore

T. Schley Gatewood Jr.

Wallace D. Mays

Beverly F. Womack

Ophthalmology

Optometry

Kenneth M. Moates

Valerie L. Moates

Ray D. Williams

Orthopedic Surgery

Robert A. Bartosh

Charles W. Davis

Pathology

Sandra L. Zornes

Podiatry

Leonard R. LaRussa

Psychiatry

Kenneth E. DiNella

Radiology

Emeka Sammy Oraka

Urology

Eugene S. Greenberg

Allied Health Practitioners

(select Allied Health Practitioners to view the listing)

Plan Design Summary

Tier Definition

Tier 1- In Network Service provided by Sumter Regional Hospital and participating SGHA providers

Tier 2- Not available Services provided outside Sumter & Dougherty Counties by participating Southcare PPO providers

Tier 3- Non Contracted services

Plan Design	In-Network Tier 1	Not Available Tier 2	Out-of-Network Tier 3
Lifetime Maximum	1,000,000 combined maximum	1,000,000 combined maximum	1,000,000 combined maximum
Calendar Year Deductible	$300	$500	$750
Out-of-Pocket Maximum Cost including Deductible	$5,000	$5,000	no limit
Physician Office Visits	100% after $20 co-pay	70% after deductible	50% R&C subject to deductible
In-House Physician (radiologist, pathologist, anesthesiologist)	80% after deductible	70% after deductible	50% R&C subject to deductible
Preadmission Testing	80% after deductible	70% after deductible	50% R&C subject to deductible
Hospital Services	80% after deductible	70% after deductible	50% R&C subject to deductible
Emergency Room Visit	100% accidental non-emergency 50% after deductible	100% accidental non-emergency 50% after deductible	100% accidental non-emergency 50% after deductible
Psychiatry / Drug / Alcohol Inpatient	80% after deductible	70% after deductible	50% R&C subject to deductible
Psychiatry / Drug / Alcohol Outpatient	80% after deductible	70% after deductible	50% R&C subject to deductible
Wellness Benefit	100% up to $500 maximum per family per calendar year	Not covered	Not Covered
Other Covered Expenses	80% after deductible	70% after deductible	50% R&C subject to deductible
Spinal Manipulation	100% after co-pay 20 visits maximum per calendar year	70% after deductible 20 visits maximum per calendar year	50% R&C subject to deductible 20 visits maximum per calendar year
Home Health Care	80% after deductible 120 maximum per calendar year	70% after deductible 120 maximum per calendar year	50% R&C subject to deductible 120 maximum per calendar year
Hospice Care	80% after deductible $25,000 inpatient and outpatient lifetime maximum	70% after deductible $25,000 inpatient and outpatient lifetime maximum	50% R&C subject to deductible
Physical/Speech Therapy	80% after deductible	70% after deductible	50% R&C subject to deductible

ID Card

Obtain ID Card from patient to insure benefit status.

Claims & Eligibility

Capital Administrators

P.O. Box 346

Alpharetta, GA 30009

1 (888) 650-6566

Pre-Certification Requirements

1 800-275-1604

Laboratory Instructions

Lab work performed by Sandra L. Zornes, MD and Southern laboratory and Pathology Serviced, PC at Sumter Regional Hospital will be considered an in-network benefit.

Call Tommy Carter (924.6011, Extension 2394) to arrange for the courier service at the hospital to pick up your specimens for Dr. Zornes and the clinical laboratory.

Lab work performed at SGHA participating physician�s office will be considered an in-network benefit.

Tertiary Referrals

Southcare PPO