SBG is a membership association designed for self funded employers. (If you are a small business with traditional fully funded insurance needs SBG recommends that you contact our partners at Consumers Life.)

As a value based purchasing coalition, SBG negotiates medical services on behalf of our members. SBG contracts with the providers setting rates and reimbursements, access points, and services. We seek out all services necessary for a self funded plan to have an inclusive arrangement to use as their preferred provider network for their health plan.  SBG uses a direct to provider contracting model.

Primary Service Area: The primary service area is Chatham, Effingham, Bryan, Long, McIntosh, and Liberty Counties in Georgia.

Secondary Service Area: The secondary area extends out to the towns of Hilton Head, Jesup, Brunswick, and Statesboro; for a total of 21 counties.

Overview of Program: The SBG program was designated for development in 1985 by the SBG Board of Trustees. Requests for provider participation were sent out to local health care providers in 1986. Over the past 20 years the network has grown. Today we have under contract a two hospital health system, a physician network, utilization review, pharmacy managers, home care, laboratory, and all other necessary ancillary services including repricing and an out of area wrap network.

Provider Participants: (a partial list as of January 1, 2008)

    St. Joseph’s Candler Health System
    Candler Hospital
    St. Joseph’s Hospital
    Telfair Women’s Hospital
    The Care Network (over 700 physicians)
    The Mayo Clinic - Jacksonville
    Lord’s Eye Care - Savannah, Springfield, Brunswick
    Envision - Pharmacy Benefit Manager
    Quantum Coordinated Health - An advanced Management Coordinator
Program Characteristics:
The SBG network operates as a Preferred Provider Organization (PPO).
Participating providers are required to: 

- participate in and support Utilization review process 

- participate in and support Quality improvement Programs   

- meet credentialing requirements - accept reimbursement rates

Hospitals are required to maintain quality assurance programs and certifications.

Physicians are obligated to accept fees as full payments with no balance billing for covered services.

Coalition members are independent self insured health plans and maintain control of their own plan designs. Each employer member may select their own administrators and choose which SBG contract they participate in.

Employers that use SBG’s primary PPO contract and the repricing system automatically have access to a no cost Southcare PPO wrap.

Utilization Review Program: The SBG requirement for utilization review has been in place since 1984 and is required for participation in the program. SBG’s preferred UR agency is Quantum Coordinated Health. Quantum is an advanced management group that focuses on the patient.  They do handle the traditional utilization review and case management responsibilities but they are much more very and hands-on. This is an optional SBG program and not a participation requirement but employers are required to have an equivalent UR program.

Repricing and Data Warehouse: SBG has a contracted to provide claims repricing at no cost to members. This agency will receive and reprice claims to assure correct contract pricing. Claims are then forwarded to the member’s administrator; electronic submission is our preferred method. This agency captures claims data and warehouses the data to support SBG’s performance incentive programs.

Patient Contract Benefits
SBG has been able to negotiate additional service features beyond the traditional network offerings, listed below are some examples of such features. More specific information regarding the network is available under the Network section of this website.

•     Every mother that delivers at the PPO hospital will receive a free car seat

•     Bearly Sick (this program offers free daycare to your employees children that are too sick for school or daycare but not sick enough to have there parent stay home.)

•     Care Call Center (employee resource for nurse triage, network directory info, scheduling and support group info.)

•     Motel (for those patients traveling extended distances to receive surgical services the network will provide lodging assistance.)

•     Taxi (for those patients that who are unable to keep their scheduled appointments due to transportation difficulties the network will assist by arranging a taxi to transport the patient to such scheduled appointment.)

•      Patient Representative (a contact at each hospital for patients if they have any problems or concerns reports back to SBG monthly on problems or concerns if any arise.)