SGHA
Physician Listing
Allied Health
Practitioners
Plan Design Summary
ID Card
Claims & Eligibility
Information
Pre-Cert
Requirements
Laboratory Instructions
Tertiary
Referrals
Physician Listing
Primary Care Physicians Internal
Medicine Pediatrics Anesthesiologist
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
David Campbell
Audrey M. Hodge
B. Bret Law
John M. Raines
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
Gary Rzeznik
Jamie Steinsapir
Yoo T. Suh
Steven Toro
Top
Pediatrics
Andrew C. Carlson
Judy Y. Y. Cheng
Raymond C. Ho
Nelson T. Madrazo
Anesthesiologist
Ali Fooman
Judy G. Johnson
Ear, Nose & Throat (ENT)
Emergency Medicine
Ben C. Andrews Jr.
Linda K. Hudson
Charles R. Sheffield
Top
Endocrinology
Jamie Steinsapir
Gastroenterology /Internal Medicine
Yoo T. Suh
General Surgery
John B. Davis
Douglas R. Joyner
Harvey L. Simpson
Glenn E. Summers
Gynecology /Gynecologic Oncology
A. Gatewood Dudley
Top
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
Chanh M. Tu
Top
Optometry
David A. Hart
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
Radiology
Urology
Eugene S. Greenberg
Allied
Health Practitioners
(select Allied Health Practitioners to view the
listing)
Top
Plan Design Summary
| Plan Design |
In-Network |
Out-of-Network |
Comments |
| Lifetime Maximum |
2,000,000 |
2,000,000 |
none |
| Calendar Year Deductible |
$350 |
$500 |
none |
| Out-of-Pocket Maximum Cost including Deductible |
$1,000 |
$2,000 |
none |
| Physician Office Visits |
100% $10 co-pay |
70% after deductible |
none |
| In-House Physician (radiologist, pathologist,
anesthesiologist) |
90% |
70% |
none |
| Preadmission Testing |
90% |
70% |
none |
| Hospital Services |
90% |
70% |
none |
| Emergency Room Visit |
100%
$50 co-pay |
70%
$50 co-pay |
none |
| Psychiatry / Drug / Alcohol
|
90% |
70% |
none |
| Psychiatry / Drug / Alcohol
|
90% |
70% |
psychiatry 52 visits per calendar
year
Drug/Alcohol 30 visits per calendar year |
| Wellness Benefit |
100% up to $250 |
100% up to $250 |
none |
| Other Covered Expenses |
90% |
70% |
none |
|
|
90% |
70% |
$1,000 maximum per calendar year |
|
|
90% |
90% |
100 visits maximum per calendar
year |
|
|
100% |
100% |
$20,000 lifetime maximum |
|
|
90% |
70% |
30 visits maximum per calendar
year |
ID Card
Obtain ID Card from patient to insure
benefit status.
Claims &
Eligibility
Gallagher Benefit Administrators
P.O. Box 5227
Lisle, IL 60532
1 (800) 345-0109
Pre-Certification
Requirements
1 (800) 538-5222
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.
- Lab
work performed at Phoebe Putney Memorial Hospital or a Phoebe Health Partner�s
physician�s office will be considered in-network.
- Any
other laboratory charges will be considered out-of-network.
Tertiary Referrals
| 
