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PPO Network

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PPO Network
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Welcome to the GHC-SCW PPO Network!

At GHC-SCW, we partner with Multiplan, the parent company of HealthEOS and Private Healthcare Systems (PHCS), to provide you with a selection of providers and hospitals throughout the United States.

  • HealthEOS is a health care cost management company with over 18,000 health care providers throughout Wisconsin. HealthEOS is the primary network if you live in Wisconsin.
  • PHCS is one of the largest preferred provider networks with over 1,000,000 health care providers in the country. PHCS is the primary network if you live outside of Wisconsin.

Choose a Provider & Specialty Care

You can easily find a provider in the PPO network by using the PPO Provider Portal. The button below will take you to the PPO Provider Portal on the MultiPlan website where you can view and choose from available providers.

 

If you need specialty care, you may visit any in-network preferred Specialty Care Provider. To verify that the specialist is an in-network preferred Specialty Care Provider, use the PPO Provider Portal to search by name or location.

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Virtual Care

Members with PPO 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®

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Emergency Care

In the event of a life-threatening emergency, visit one of the hospital emergency rooms participating in the Preferred 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.

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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

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PPO Frequently Asked Questions

A PPO network includes the facilities, providers and suppliers that GHC-SCW has contracted with to provide health care services. GHC-SCW has partnered with HealthEOS and Private Healthcare Systems (PHCS) to provide you with a selection of providers and hospitals throughout the United States.

An in-network provider is a GHC-SCW clinic provider, a HealthEOS provider for those members who live in Wisconsin or a PHCS provider for those members who live outside of Wisconsin. Providers must be accessed appropriately depending on where you live and where you may be traveling.

Examples include, but are not limited to:

  • Orthopedists
  • Cardiologists
  • Pulmonologists
  • Oncologists
  • Gynecologists

If you need medical care while traveling or you are a dependent who lives away from home, use the PPO Provider Portal to find a nearby provider. If you have questions regarding the provider networks, contact PCHS at (800) 922 4362 or HealthEOS at (800) 279-9776 to verify further or nominate the provider.

Be sure to contact GHC-SCW before receiving care only if it is for a service that requires prior authorization.

Please note that if the provider does not participate in the Preferred Provider Network, your out-of-pocket costs may be greater.

When you use in-network providers, you may have fewer out-of-pocket costs. If you receive services from an out-of- network provider, your out-of-pocket costs will most likely be greater.

If the GHC-SCW PPO 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.

When you visit an in-network provider, claims will be forwarded to the Preferred Provider Network. If you choose to see an out-of-network provider, you may be required to pay at the time of service and submit the claims to the Preferred Provider Network yourself.

If your provider is not listed or if you have additional questions regarding the provider networks, contact PHCS at (800) 922-4362 or HealthEOS at (800) 279-9776 to verify further or nominate the provider.

Call To Action

Still have questions about what is covered under your PPO insurance plan?

Call GHC-SCW Member Services at (608) 828-4853 or toll-free at (800) 605-4327.