Sentara Health Plans, Inc.


4417 Corporation Lane
Virginia Beach, VA 23462
Telephone: (757) 552-7401
Fax: (757) 552-7396
Member services: (877) 552-7401
Provider services: (757) 552-7474/ (800) 229-8822

Web site: www.sentara.com

Key Staff
President – Michael M. Dudley
Medical Director – George K. Heuser, MD
Director of Provider Relations – Rachel Schneider
Government Relations – Stephen Ford

Other Contacts
General Company Information – Melinda Albert
Grievance/Appeals Procedures – Stephen Ford
Quality Improvement – George K. Heuser, MD
Pharmacy Benefits – Deno Sebastian

Specialized Health Care Services
Service In-House Contracted
Mental Health X
Pharmacy Benefit Mgmt. X
Vision Care X- Eye Med
Dental Care X- Dominion Dental
Disease Mgmt. X
Utilization Mgmt. X

 

Market Segment
Market Segment HMO/POS PPO Medicare Advantage Medicaid
Individual X X X
Small Group (2-49 Employees) X X
Large Group (50+ Employees) X X
Administrative Services Only (ASO) X X

 

Network Providers Under Contract (numbers are combined HMO/PPO)
Network Providers HMO PPO PAR
PCPs 2110 2454
Physician Specialists 6187 6809
Hospitals 41 13
OB/GYNs 389 416

 

Enrollment (as of January 31, 2007)
Standard HMO 144889
Medicaid HMO 121056
Point-of-Service (POS) 32990
PPO 39781
Medicare Advantage PPO 1577

 

Virginia HMO Service Area:
Counties
Accomack, Amelia, Brunswick, Chesterfield, Cumberland, Dinwiddie, Essex, Gloucester, Goochland, Greensville, Hanover, Henrico, Isle of Wight, James City, King & Queen, Lancaster, Lunenburg, Mathews, Mecklenburg, Middlesex, New Kent, Northampton, Northumberland, Powhatan, Prince Edward, Prince George, Richmond, Southampton, Surry, Sussex, York

Cities
Chesapeake, Colonial Heights, Emporia, Franklin, Hampton, Newport News, Norfolk, Portsmouth, Poqouson, Richmond, Suffolk, Virginia Beach, Williamsburg.