HMO Network
Welcome to the GHC-SCW HMO Network!
The HMO Network emphasizes on high-quality, preventive health care with a strong relationship with a Primary Care Provider and access to area Specialists. This plan is available for members that live or work in Dane, Columbia, Grant, Iowa, Jefferson, Juneau, Lafayette and Sauk County.
The HMO network includes 33 primary care clinics in Dane County and an additional 40+ primary care clinics in the region.
Members with an HMO plan have access to over 2,000 UW-Health specialists along with access to UW-Health hospitals and the UnityPoint Health – Meriter Hospital.
Find a Provider
You can easily find a primary or specialty care provider in the HMO network by clicking the button below.
Our Provider Search tool will first ask you to select your HMO network (written on your member ID card). Then you can view and choose from available providers.
If you need specialty care, you may visit an in-network Specialty Care Provider. To verify that the specialist is an in-network Specialty Care Provider, use the button below to search by name or location.
Virtual Care
Members with HMO insurance have access to virtual care benefits, which are handy when you’re having unusual symptoms and need some peace of mind or just need a quick follow up with your provider to go over new medications you’ve been recently prescribed. Our virtual care options are a convenient and safe way to get the care you need at home or on the go.
- GHC NurseConnect
- Video Visit Using GHCMyChartSM
- Virtual Urgent Care powered by KeyCare
- Virtual Therapy powered by MDLIVE®
Emergency Care
In the event of a life-threatening emergency, visit one of the hospital emergency rooms participating in the HMO Provider Network. If that is not possible, proceed immediately to the nearest hospital emergency room. In both situations, contact the GHC-SCW Care Management Department at (608) 257-5294 or toll-free at (800) 605-4327, and request Care Management within 48 hours of receiving emergency services or as soon thereafter as reasonably possible.
Prior Authorization
Prior Authorization is the process by which GHC-SCW provides prior written approval for coverage of specific benefits, treatments, Durable and Disposable Medical Equipment (DME), Prescription Drugs and supplies. The purpose of Prior Authorization is to determine and authorize the following:
- The specific type and extent of care, Durable and Disposable Medical Equipment, Prescription Drug or supply that is necessary.
- The number of visits, or the period of time, during which care will be provided.
- The Provider to whom the Member is being referred.
- Whether the Member should receive coverage for the services from an out-of-network Provider because necessary services are not available from an in-network Provider.
If Prior Authorization is not received prior to the date of service and/or receipt of supplies, your Provider should contact GHC-SCW’s Care Management Department for a determination of Medical Necessity. The Prior Authorization lists may differ depending on your health plan. Please contact Care Management at (608) 257-5294.
HMO Frequently Asked Questions
A HMO network includes the facilities, providers and suppliers that GHC-SCW has contracted with to provide health care services. GHC-SCW has partnered with other health care systems in region to provide you with a selection of providers and hospitals throughout south central Wisconsin.
An in-network provider is a GHC-SCW clinic provider or a contracted clinic provider within the HMO network. Use the “Find a Provider” button on the upper right-hand corner of this page to see who is in-network.
Examples include, but are not limited to:
- Orthopedists
- Cardiologists
- Pulmonologists
- Oncologists
- Gynecologists
GHC-SCW has several virtual options that are available to members who are traveling. These include:
- GHC NurseConnect
- Virtual Urgent Care powered by KeyCare
- Virtual Therapy powered by MDLIVE®
If it’s an emergency, please visit the nearest emergency room or call 911.
If the GHC-SCW HMO Network includes a Copayment, you may be asked to pay this amount at the time of your visit.
If you choose an out-of-network provider, you may be required to pay in full at the time of service.
If your provider is not listed or if you have additional questions regarding the provider networks, call GHC-SCW Member Services at (608) 828-4853 or toll-free at (800) 605-4327.
Still have questions about what is covered under your HMO insurance plan?
Call GHC-SCW Member Services at (608) 828-4853 or toll-free at (800) 605-4327.