Georgia Health Advantage

Georgia Health Advantage HMO Plan Provider Directory

This directory provides a list of Georgia Health Advantage’s current network providers for the following Georgia counties:

Appling, Bacon, Baker, Baldwin, Banks, Bartow, Ben Hill, Berrien, Bibb, Bleckley, Brantley, Brooks, Bryan, Bulloch, Burke, Calhoun, Candler, Chatham, Chattahoochee, Chattooga, Cherokee, Clay, Clinch, Cobb, Coffee, Colquitt, Coweta, Crawford, Crisp, Dade, Dawson, Dougherty, Douglas, Echols, Emanuel, Evans, Fayette, Franklin, Gilmer, Glascock, Gordon, Greene, Habersham, Hancock, Harris, Hart, Heard, Henry, Houston, Irwin, Jasper, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Lamar, Lee, Liberty, Lincoln, Long, Lumpkin, Macon, Madison, Marion, McDuffie, McIntosh, Meriwether, Miller, Mitchell, Monroe, Montgomery, Muscogee, Newton, Oconee, Oglethorpe, Paulding, Peach, Pickens, Pierce, Polk, Pulaski, Putnam, Quitman, Randolph, Richmond, Rockdale, Schley, Screven, Spalding, Stephens, Stewart, Sumter, Talbot, Taliaferro, Tattnall, Taylor, Telfair, Terrell, Tift, Toombs, Treutlen, Turner, Twiggs, Upson, Walton, Ware, Warren, Washington, Wayne, Webster, Wheeler, Wilcox, Wilkes, Wilkinson and Worth.

To request a hard copy of Georgia Health Advantage’s provider directory, please call our Member Service Department at 844-917-0645, 8 a.m. to 8 p.m. seven (7) days a week October 1 through March 31, and Monday to Friday April 1 through September 30.

Georgia Health Advantage will mail a hard copy of the provider directory to you within three (3) business days of your request. Georgia Health Advantage may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the provider directory in hard copy permanently.

If you request it, your request for hard copies of the provider directory remains until you leave Georgia Health Advantage or request that hard copies be discontinued.

Georgia Health Advantage will also provide information to individuals in alternate formats (i.e. Large Print), upon request and thereafter, as outlined in Section 504 of the Rehabilitation Act of 1973.

Introduction

You will have to choose one of our network providers listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP.

Since we are a Health Maintenance Organization (HMO), it is necessary for you to select a PCP to utilize while on the plan. Your PCP will get to know you and your health, and you can establish a trusting and long-lasting relationship. Your PCP can help you arrange or coordinate your covered services. This includes x-rays, laboratory tests, therapies, specialists, skilled nursing facility admissions, hospital admissions, and follow-up care. Your PCP also contacts

other plan providers for updates about your care and/or treatment. In some cases, your PCP or provider will need to get prior authorization (prior approval).

The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory; however, some services may require a referral or prior authorization. If you have been going to one Network Provider, you are not required to continue to go to that same Network Provider. We do not guarantee that each provider is still accepting new members. Please contact the provider to determine if he or she is accepting new patients.

In some cases, you may get covered services from non-network providers. If you get a bill from a non-network provider, you should not pay the bill but should submit it to Georgia Health Advantage for processing. We can help determine how much you are responsible for paying, if any.

Emergency care can always be obtained in or out of the service area from the nearest available provider. When in the service area, you must use network providers for urgent care. When out of the service area or when network providers are unavailable, urgent care may be obtained from the first available qualified provider. In addition, when out of the service area, you can obtain dialysis treatment from any Medicare certified dialysis provider.

Emergency care can always be obtained in or out of the service area from the nearest available provider. When out of the service area or when network providers are unavailable, urgent care may be obtained from any qualified provider. In addition, when out of the service area, you can obtain dialysis treatment from any Medicare qualified dialysis provider.

You must use network providers except in emergency, urgent care situations, or for out-of-area dialysis, as described above. If you obtain routine care from out-of-network providers, neither Medicare nor Georgia Health Advantage will be responsible for the costs.

What is the service area for Georgia Health Advantage?

The counties in our service area are listed below.

Appling, Bacon, Baker, Baldwin, Banks, Bartow, Ben Hill, Berrien, Bibb, Bleckley, Brantley, Brooks, Bryan, Bulloch, Burke, Calhoun, Candler, Chatham, Chattahoochee, Chattooga, Cherokee, Clay, Clinch, Cobb, Coffee, Colquitt, Coweta, Crawford, Crisp, Dade, Dawson, Dougherty, Douglas, Echols, Emanuel, Evans, Fayette, Franklin, Gilmer, Glascock, Gordon, Greene, Habersham, Hancock, Harris, Hart, Heard, Henry, Houston, Irwin, Jasper, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Lamar, Lee, Liberty, Lincoln, Long, Lumpkin, Macon, Madison, Marion, McDuffie, McIntosh, Meriwether, Miller, Mitchell, Monroe, Montgomery, Muscogee, Newton, Oconee, Oglethorpe, Paulding, Peach, Pickens, Pierce, Polk, Pulaski, Putnam, Quitman, Randolph, Richmond, Rockdale, Schley, Screven, Spalding, Stephens, Stewart, Sumter, Talbot, Taliaferro, Tattnall, Taylor, Telfair, Terrell, Tift, Toombs, Treutlen, Turner, Twiggs, Upson, Walton, Ware, Warren, Washington, Wayne, Webster, Wheeler, Wilcox, Wilkes, Wilkinson and Worth.

How do you find Georgia Health Advantage providers that serve your area?

This is a searchable online document and is updated monthly. You can enter areas in the fields to narrow down your search. For example, if you enter “Georgia” in the state field, and “Oconee” in the county field, the search engine will generate a list of all providers, hospitals and skilled nursing facilities in Oconee, Georgia. You can also search by provider name, city, or specialty.

If you have questions about Georgia Health Advantage, require assistance in selecting a PCP, or need to report errors in this directory, please call our Member Service Department at 844-917- 0645, from 8 a.m. to 8 p.m. seven (7) days a week October 1 through March 31, and Monday to Friday April 1 through September 30. TTY/TDD users should call 711. You can also visit georgiahealthadvantage.com.

This directory was Last Updated on October 5, 2021

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Georgia Health Advantage, offered by Georgia Assurance, Inc., is a Health Maintenance Organization (HMO) with a Medicare contract. Enrollment in Georgia Health Advantage depends on contract renewal.

The provider network may change at any time. You will receive notice when necessary.