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1997 DIRECTORY OF MANAGED CARE PROVIDERS (OKLAHOMA)

Posted On: Dec. 28, 1997 12:00 AM CST

MultiPlan Inc.
115 Fifth Ave., New York, N.Y. 10003; 212-780-2000; fax: 212-843-3517
Staff/Facilities
Primary practitioners*NA
Specialists*NA
Hospitals54
Users: Group Health
Employer/payer groups18
Employees & dependents242,847
Service area: Oklahoma: statewide, excluding Adair, Alfalfa, Beaver, Cimarron, Dewey, Ellis, Grant, Harmon, Jefferson, Love, Major, Marshall, Noble, Okfuskee and Texas counties.
**Practitioner network not yet established.
See MultiPlan Inc. consolidated listing under New York.
National Ear Care Plan
6825 E. Tennessee Ave., Suite 415, Denver, Colo. 80224-1632; 303-399-1212; fax: 303-399-7719
Specialty: hearing
Staff/Facilities
Primary practitioners10
Service area: Oklahoma: cities of Edmond, Lawton, Norman, Oklahoma City, Shawnee, Stillwater and Tulsa.
See National Ear Care Plan consolidated listing under Colorado.
National Preferred Provider Network Inc.
419 E. Main St., Middletown, N.Y. 10940; 914-343-1600; fax: 914-343-6113
Staff/Facilities
Primary practitioners1,448
Specialists2,587
Hospitals74
Users: Group Health
Employer/payer groups24
Employees & dependents107,978
Total Users107,978
Service area: Oklahoma.
See National Preferred Provider Network Inc. consolidated listing under New York.
PPO Oklahoma Inc.
3503 N.W. 63rd St., Suite 304, Oklahoma City, Okla. 73116; 405-843-9551; fax: 405-843-0956
Staff/Facilities
Primary practitioners1,329
Board-certified87%
Specialists2,507
Hospitals92
Pharmacies342
Users: Group Health
Employer/payer groups407
Employees & dependents172,200
Users: Workers Compensation
Employer/payer groups620
Single coverage200,000
Total Users372,200
Operational date: July 1992.
For profit.
Service area: Oklahoma: statewide.
Services: General medical, vision, prescription drug, mental health, workers compensation. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, insurers; charges flat fee per employee, by percent of savings, by percent of services by doctors/hospitals.
UR: Standard procedures excluding hospital bill audits. UR provided by outside contractors.
Officers: Martin Sholder, president; Dr. Walter Bell, medical director; Sandra Bulow-Hube, executive vp-operations.
Contact: Melanie Gray, marketing.
PacifiCare of Oklahoma
7666 E. 61st St., Tulsa, Okla. 74133; 918-459-1100; fax: 918-459-1452
Staff/Facilities
Primary practitioners383
Board-certified66.6%
Specialists1,194
Hospitals15
Pharmacies680
Primary care locations148
Users
Employer/payer groups730
Single coverage14,712
Family coverage16,522
Employees & dependents67,242
Medicare25,888
Total139,414
Revenues
First-half 1997$136,052,354
1996$257,568,779Operational date: October 1985.
Federally qualified.
Licensed in: Oklahoma.
Model type: Group.
Service area: Oklahoma: 32 counties. Member of Covantage.
Contracts with PacifiCare Behavioral Health Inc. for mental health in Oklahoma; Pearle Inc. for vision in Oklahoma; Prescription Solutions for pharmacy in Oklahoma; United Dental for dental in Oklahoma.
Services: General medical. May be customized to meet employer specifications.
Rating options: Community rating by class.
Offers self-insured products.
Point-of-service contracts: 1% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries.
Officers: Pat Feyen, regional vp; Chris Whitty, president/CEO; Dr. Laurie Greenberg, medical director; Jim Jones, vp-marketing; Dan Comrie, vp/CFO.
Contact: Shari Holt, 918-459-1285.
See PacifiCare Health Systems HMO/POS consolidated listing under California.
Preferred Community Choice PPO Inc.
218 W. Sixth, Tulsa, Okla. 74119; 918-594-5212; fax: 918-594-5210
Staff/Facilities
Primary practitioners1,325
Board-certified55%
Patients/practitioner261
Specialists2,637
Hospitals77
Users: Group Health
Employer/payer groups10,405
Single coverage150,241
Employees & dependents345,554
Ownership: CommunityCare Managed Healthcare Plans of Oklahoma.
Operational date: March 1994.
For profit.
Service area: Oklahoma: 63 counties.
Services: General medical, mental health, chiropractic. Services available unbundled. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, facilities; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by the PPO.
Officers: David Pynn, president; Keith Harvey, vp-PPO; Dr. Jack E. Sommers, medical director; Earle Rice, CFO; John Brandt, marketing manager.
Contact: John Brandt, 918-594-5213.
Preferred Health Network
301 E. Ocean Blvd., Suite 900, Long Beach, Calif. 90802; 562-983-1616; fax: 562-436-4389
Staff/Facilities
Primary practitioners311
Specialists599
Hospitals34
Users: Group Health
Employer/payer groups321
Employees & dependents26,384
Total Users26,384
Operational date: April 1991.
Service area: Oklahoma: 31 counties.
Services: General medical, vision, mental health.
See Preferred Health Network consolidated listing under California.
Private Healthcare Systems
222 W. Las Colinas Blvd., Suite 1800, Irving, Texas 75039; 972-869-1451; fax: 972-869-2327
Staff/Facilities
Primary practitioners864
Board-certified82%
Specialists1,322
Hospitals24
Pharmacies764
Users: Group Health
Employees & dependents36,731
Total Users36,731
Operational date: May 1987.
Service area: Oklahoma: cities of Enid, Oklahoma City, Ponca City, Shawnee and Tulsa.
See Private Healthcare Systems PPO consolidated listing under Massachusetts.
Private Healthcare Systems Inc.
222 W. Las Colinas Blvd., Irving, Texas 75039; 972-432-1451;
fax: 972-869-2327
Staff/Facilities
Primary practitioners389
Board-certified82%
Specialists1,322
Hospitals24
Pharmacies764
Users
Employees & dependents474
Total474Service Area: Oklahoma: cities of Oklahoma City and Tulsa.
See Private Healthcare Systems POS consolidated listing under Massachusetts.
Prudential HealthCare HMO-Oklahoma City
4005 N.W. Expressway, Suite 300, Oklahoma City, Okla. 73112; 405-879-1780; fax: 405-879-1774
Staff/Facilities
Primary practitioners320
Board-certified74%
Specialists981
Hospitals50
Pharmacies219
Primary care locations78
Users
Single coverage10,015
Family coverage10,661
Employees & dependents45,626
Total45,626Operational date: April 1981.
Federally qualified.
Licensed in: Oklahoma.
NCQA fully accredited.
Model type: Group.
Service area: Oklahoma: 44 counties.
Services: General medical, prescription drug.
Officers: James McNaughton, executive director; Tim McFall, marketing director; Bob Warren, provider relations; Kathleen Musser, medical director; Juanita Clessna, case management.
Contact: Tim McFall, 405-879-1780.
See Prudential HealthCare HMO consolidated listing under New Jersey.
Prudential HealthCare HMO-Tulsa
7912 E. 31st Court, Suite 300, Tulsa, Okla. 74145; 918-624-4664; fax: 918-624-9759
Staff/Facilities
Primary practitioners54
Board-certified70%
Specialists289
Hospitals8
Pharmacies108
Primary care locations10
Users
Single coverage5,797
Family coverage6,843
Employees & dependents27,978
Total27,978Operational date: January 1983.
Federally qualified.
Licensed in: Oklahoma.
NCQA fully accredited.
Model type: Group.
Service area: Oklahoma: Creek, Mayes, Muskogee, Nowata, Okmulgee, Osage, Pawnee, Rogers, Tulsa, Wagoner and Washington counties.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled.
Point-of-service contracts: 40% of members are enrolled.
Officers: Ann Paul, executive director; Brian Forbes, marketing director; Michelle Crawford, provider relations; Dr. Tobie Bresloff, medical director; Kris Desrosjers, case management.
Contact: Brian Forbes, 918-624-4600.
See Prudential HealthCare HMO consolidated listing under New Jersey.
Prudential HealthCare POS-Oklahoma City
4005 N.W. Expressway, Suite 300, Oklahoma City, Okla. 73112
Staff/Facilities
Primary practitioners479
Board-certified73%
Specialists1,005
Hospitals51
Pharmacies219
Primary care locations79
Users
Single coverage8,690
Family coverage10,555
Employees & dependents40,818
Total40,818Operational date: January 1987.
Licensed in: Oklahoma.
NCQA fully accredited.
Model type: IPA.
Service area: Oklahoma: 47 counties.
Services: General medical, prescription drug.
Officers: James McNaughton, executive director; Tim McFall, marketing director; Bob Warren, provider relations; Dr. Kathleen Musser, medical director; Juanita Clessna, case management.
Contact: Tim McFall, 405-879-1780.
See Prudential HealthCare POS consolidated listing under New Jersey.
Prudential HealthCare POS-Tulsa
7912 E. 31st Court, Suite 300, Tulsa, Okla. 74145; 918-624-4664; fax: 918-624-9759
Staff/Facilities
Primary practitioners340
Board-certified78%
Specialists568
Hospitals12
Pharmacies108
Primary care locations14
Users
Single coverage7,530
Family coverage12,974
Employees & dependents49,479
Total49,479Operational date: July 1986.
Licensed in: Oklahoma.
NCQA fully accredited.
Model type: IPA.
Service area: Oklahoma: Craig, Creek, Delaware, Haskell, Latimer, Le Flore, Mayes, Muskogee, Nowata, Okmulgee, Ottawa, Osage, Pawnee, Rogers, Sequoyah, Tulsa, Wagoner and Washington counties.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled.
Officers: Ann Paul, executive director; Brian Forbes, marketing director; Michelle Crawford, provider relations; Dr. Tobie Bresloff, medical director; Kris Desrosiers, case management.
Contact: Brian Forbes, 918-624-4600.
See Prudential HealthCare POS consolidated listing under New Jersey.
Prudential HealthCare PPO-Oklahoma City
4005 N.W. Expressway, Suite 300, Oklahoma City, Okla. 73112; 405-879-1780; fax: 405-879-1774
Staff/Facilities
Primary practitioners479
Board-certified73%
Specialists568
Hospitals12
Pharmacies14
Operational date: January 1991.
Service area: Oklahoma: 47 counties.
Services: General medical, prescription drug, mental health. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by discount off customary rates; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures, excluding outpatient service predetermination. UR provided by the PPO.
Officers: James McNaughton, executive director; Tim McFall, marketing director; Bob Warren, provider relations; Dr. Kathleen Musser, medical director.
Contact: Tim McFall.
See Prudential HealthCare PPO consolidated listing under New Jersey.
Prudential HealthCare PPO-Tulsa
7912 E. 31st Court, Suite 300, Tulsa, Okla. 74145; 918-624-4664; fax: 918-627-9759
Staff/Facilities
Primary practitioners340
Board-certified78%
Specialists568
Hospitals12
Pharmacies108
Operational date: January 1991.
Service area: Oklahoma: Craig, Creek, Delaware, Haskell, Latimer, Le Flore, Mayes, Muskogee, Nowata, Okmulgee, Ottawa, Osage, Pawnee, Rogers, Sequoyah, Tulsa, Wagoner and Washington counties.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures, excluding outpatient service predetermination. UR provided by the PPO.
Officers: Ann Paul, executive director; Brian Forbes, marketing director; Michelle Crawford, provider relations; Dr. Tobie Bresloff, medical director.
Contact: Brian Forbes, 918-624-4600.
See Prudential HealthCare PPO consolidated listing under New Jersey.
USA H&W Network
7301 N. 16th St., Suite 201, Phoenix, Ariz. 85020; 602-371-3860; fax: 602-371-3889
Staff/Facilities
Primary practitioners656
Specialists886
Hospitals44
Users: Group Health
Single/family coverage33,582
Employees & dependents77,238
Total Users77,238
Operational date: May 1986.
Service Area: Oklahoma: 49 counties.
See USA H&W Network consolidated listing under Arizona.
USA Workers' Injury Network
916 S. Capital of Texas Highway, Austin, Texas 78746; 512-306-0201; fax: 512-328-6785
Specialty: workers compensation
Staff/Facilities
Primary practitioners446
Specialists832
Hospitals43
Users: Workers Compensation
Single coverage99,688
Total Users99,688
Operational date: May 1986.
Service area: Oklahoma: 49 counties.
See USA Workers' Injury Network consolidated listing under Texas.
United HealthCare Insurance Co.Oklahoma City
Promerica-United HealthCare, 1250 E. Copeland Road, Arlington, Texas 76011; 817-436-5200
Staff/Facilities
Primary practitioners243
Board-certified73%
Specialists699
Hospitals8
Pharmacies198
Users:
Employer/payer groups263
Total Users14,592
Operational date: January 1990.
Service area: Oklahoma: Canadian, Garfield, Garvin, Grady, Kingfisher, Logan, McClain, Oklahoma and Pottawatomie counties.
Services: General medical, prescription drug, mental health/substance abuse.
Contact: Marty Foster, vp-sales.
See United HealthCare Corp. PPO consolidated listing under Minnesota.
United HealthCare Insurance Co.-Tulsa
Promerica-United HealthCare, 1250 E. Copeland Road, Arlington, Texas 76011; 817-436-5200
Staff/Facilities
Primary practitioners342
Board-certified74%
Specialists732
Hospitals7
Pharmacies203
Users:
Employer/payer groups326
Total Users23,625
Operational date: January 1986.
Service area: Oklahoma: Creek, Hughes, Latimer, Lincoln, Mayes, Muskogee, Nowata, Okmulgee, Osage, Pawnee, Payne, Pittsburg, Rogers, Tulsa, Wagoner and Washington counties.
Services: General medical, prescription drug, mental health/substance abuse.
Contact: Marty Foster, vp-sales.
See United HealthCare Corp. PPO consolidated listing under Minnesota.