Page 24 - SIH 2022 Re-Enrollment Guide
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Some hospitals and other locations are excluded from our medical plan. Services at these places will not be
covered by our medical plan unless it is a true emergency. A true emergency is a traumatic injury or medical
condition which occurs unexpectedly and which, if not immediately treated, might cause complications or
jeopardize the patient’s full recovery. True emergencies include heart attacks, cerebral vascular accidents
(strokes), poisonings, loss of consciousness, severe shortness of breath, profuse bleeding, broken bones, and
convulsions. Observation room services as a result of emergency room care and similar conditions may also
be determined by a physician to be medical emergencies.
Excluded Facilities and Locations from Medical Plan
Excluded Facilities
X Cedar Court Imaging in Carbondale, IL X Southern Illinois GI Specialists in Carbondale, IL
X Crossroads in Mt. Vernon, IL is excluded including physician charges under
X Deaconess Hospital in Evansville, IN Dr. Zahoor Makhdoom
X Heartland Regional Medical Center in Marion, IL X SSM Good Samaritan in Mt. Vernon, IL
X Lourdes Hospital in Paducah, KY X SSM St. Mary’s in Centralia, IL
X Physicians Surgery Center at Good Samaritan, Mt. Vernon, IL X Union County Hospital in Anna, IL (including the
X Saint Francis Medical Center in Cape Girardeau, MO Convenient Care Clinic)
X Southeast Hospital in Cape Girardeau, MO X Western Baptist in Paducah, KY
Visit askallegiance.com/SIH and click the Find a Provider tab for a listing of in-network and
excluded providers.
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covered by our medical plan unless it is a true emergency. A true emergency is a traumatic injury or medical
condition which occurs unexpectedly and which, if not immediately treated, might cause complications or
jeopardize the patient’s full recovery. True emergencies include heart attacks, cerebral vascular accidents
(strokes), poisonings, loss of consciousness, severe shortness of breath, profuse bleeding, broken bones, and
convulsions. Observation room services as a result of emergency room care and similar conditions may also
be determined by a physician to be medical emergencies.
Excluded Facilities and Locations from Medical Plan
Excluded Facilities
X Cedar Court Imaging in Carbondale, IL X Southern Illinois GI Specialists in Carbondale, IL
X Crossroads in Mt. Vernon, IL is excluded including physician charges under
X Deaconess Hospital in Evansville, IN Dr. Zahoor Makhdoom
X Heartland Regional Medical Center in Marion, IL X SSM Good Samaritan in Mt. Vernon, IL
X Lourdes Hospital in Paducah, KY X SSM St. Mary’s in Centralia, IL
X Physicians Surgery Center at Good Samaritan, Mt. Vernon, IL X Union County Hospital in Anna, IL (including the
X Saint Francis Medical Center in Cape Girardeau, MO Convenient Care Clinic)
X Southeast Hospital in Cape Girardeau, MO X Western Baptist in Paducah, KY
Visit askallegiance.com/SIH and click the Find a Provider tab for a listing of in-network and
excluded providers.
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