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1997 DIRECTORY OF MANAGED CARE PROVIDERS

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

One Health Plan
of California Inc.
1740 Technology Drive, Suite 530, San Jose, Calif. 95110; 800-798-2466 or 408-437-0272; fax: 408-437-0253
Staff/Facilities
Primary practitioners6,391
Specialists13,289
Hospitals155
Pharmacies1,233
Users
Employees & dependents39,807
Total39,807Operational date: March 1996.
Service area: California: statewide.
Officers: Jackie James, president; Dr. Rich Swanberg, medical director; Kurt Hoekendorf, executive director; Sandra Cormier, operations director.
Contact: Sandra Cormier.
See One Health Plan consolidated listing under Colorado.
Options PPO
21600 Oxnard St., Woodland Hills, Calif. 91367; 818-676-6775; fax: 818-676-6992
Staff/Facilities
Primary practitioners11,384
Board-certified81.4%
Patients/practitioner.29
Specialists25,661
Hospitals320
Pharmacies3,200
Users
Employer/payer groups572
Single coverage2,749
Family coverage1,937
Employees & dependents8,555
Users: Workers Compensation
Employer/payer groups300
Single coverage1,000,000
Total Users3,290
Ownership: Foundation Health Systems Inc.
Operational date: October 1993.
Service area: California: 48 counties.
Services: General medical, dental, vision, prescription drug, mental health, vision, workers compensation, chiropractic. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates per case, in part, for hospital ambulatory services; is compensated by employers/payers; charges premium/fees per employee/dependent.
UR: Standard procedures excluding second surgical opinion, hospital bill audits, outpatient service predetermination and including negotiable rates with non-contracted providers, UR provided by the PPO, by outside contractors.
Officers: Dr. Arthur Southam, president/CEO; Robert White, executive vp; Linda Pollnow, senior vp-operations/provider network; John McDonald, senior vp-marketing; Michael Close, senior vp-commercial sales.
Contact: David Olson, vp-investor relations, 818-676-8591.
See Foundation Health Systems consolidated listing under California.
PTPN
20955 Warner Center Lane, Woodland Hills, Calif. 91367; 800-766-7876; fax: 818-598-3200
Specialty: occupational therapy, physical therapy, speech therapy
Staff/Facilities
Primary practitioners3,500
Operational date: 1985.
For profit.
Service area: 22 states.
Services: Workers compensation, occupational therapy, physical therapy, speech therapy. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by discount off customary rates, capitated fee, discounted fee schedule; is compensated by employers/payers, providers, insurers, TPAs.
UR: Precertification, concurrent review, discharge planning, retrospective review, outpatient service predetermination, case management. UR provided by the PPO.
Officers: Michael Weiner, CEO; Nancy Rothenberg, vp; Elise Latawiec, director-quality assurance.
Contact: Lisa Burroughs, 818-598-3249.
PacifiCare
of California
5701 Katella Ave., Cypress, Calif. 90630; 714-952-1121; fax: 714-226-3914
Staff/Facilities
Primary practitioners11,997
Board-certified71%
Patients/practitioner75
Specialists18,794
Hospitals305
Pharmacies4,543
Primary care locations362
Users
Employer/payer groups12,728
Single coverage260,921
Family coverage274,664
Employees & dependents895,814
Medicare395,699
Medicaid22,618
Total1,875,879
Revenues
First-half 1997$4,224,703,000
1996$3,165,966,000Operational date: May 1978.
Federally qualified.
Licensed in: California.
NCQA fully accredited.
Model type: Group/IPA.
Service area: California: 42 counties. Member of Covantage and UltraLink. Contracts with American Chiropractors Network for chiropractic services in California; California Dental & Vision for dental and vision in California; PacifiCare Behavioral Health for mental health in California.
Services: General medical, dental, vision, prescription drug, mental health, workers compensation. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 13.5% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Brad Bowlus, president/CEO; Dave Barr, COO; Bob Novelli, vp-customer service center; Don Costa, CFO.
See PacifiCare Health Systems HMO/POS consolidated listing under California.
PacifiCare
of California PPO
5701 Katella Ave., Cypress, Calif. 90630; 714-952-1121; fax: 714-226-3914
Staff/Facilities
Primary practitioners8,977
Board-certified67.9%
Patients/practitioner16
Specialists25,907
Hospitals275
Pharmacies4,449
Users: Group Health
Employer/payer groups1,523
Single coverage7,444
Family coverage6,918
Employees & dependents28,298
Total Users28,298
Ownership: PacifiCare Health Systems.
Operational date: April 1991.
For profit.
Service area: California: 52 counties.
Services: General medical, vision, mental health. Services available unbundled. 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 second surgical opinion. UR provided by the PPO.
Officers: Brad Bowlus, president/CEO; Dave Barr, COO; Bob Novelli, vp-customer service center; Don Costa, CFO.
PacifiCare Health Systems*
3110 Lake Center Drive, Santa Ana, Calif. 92704-6921; 714-825-5200
Staff/Facilities
Primary practitioners20,369
Board-certified67%
Specialists35,891
Hospitals644
Pharmacies11,539
Primary care locations659
Users
Employees & dependents1,813,013
Revenues
First-half 1997$2,381,100
1996$1,194,718Licensed in: Arizona, California, Colorado, Nevada, Ohio, Oklahoma, Oregon, Texas, Utah and Washington.
For profit.
Service area: Arizona, California, Colorado, Nevada, Ohio, Oklahoma, Oregon, Texas, Utah and Washington.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Alan Hoops, president/CEO; Jeff Folick, COO/executive vp; Wayne Lowell, CFO/executive vp; Dr. Linda Lyons, chief medical director; Craig Schub, senior vp-marketing.
**Figures are consolidated, including all HMO/POS plans in this organization.
Preferred Health Network*
301 E. Ocean Blvd., Suite 900, Long Beach, Calif. 90802; 562-983-1616; fax: 562-436-4389
Staff/Facilities
Primary practitioners38,357
Board-certified85%
Specialists95,901
Hospitals1,169
Users: Group Health
Payer groups220
Employees & dependents2,931,177
Users: Workers Compensation
Payer groups24
Single coverage1,904,496
Total Users4,835,673
Ownership: Foundation Health Systems Inc.
Operational date: December 1982.
For profit.
Service Area: Nationwide, excluding Alaska, Hawaii, Idaho, Maine, Montana, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Utah, Vermont, West Virginia and Wyoming.
Contracts with Affiliated Healthcare in Texas; ASC/Flora in Ohio; Medichoice in New Jersey, New York, Pennsylvania; Medview in Alabama, Connecticut, Florida, Illinois.
Services: 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, case rates; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by the PPO.
Officers: Ronald E. Seibel, president/CEO; John van Haaster, vp-finance; Jonathan Fuchs, vp-network operations; Richard Hershey, vp-new business development; Dr. Vinay Sanghani, director-medical affairs.
Contact: Danny Real, director-sales/marketing, 562-628-1671.
**Figures are consolidated, including all PPO plans in this organization.
Preferred Health Network
301 E. Ocean Blvd., Suite 900, Long Beach, Calif. 90802; 562-983-1616; fax: 562-436-4389
Staff/Facilities
Primary practitioners13,780
Specialists33,730
Hospitals224
Users: Group Health
Employer/payer groups1,266
Employees & dependents950,609
Users: Workers Compensation
Employer/payer groups12
Single coverage910,136
Total Users1,860,745
Operational date: December 1982.
Service area: California: California: 54 counties.
Services: General medical, vision, mental health, workers compensation, auto carrier liability, Medicare Select.
See Preferred Health Network consolidated listing under California.
Private Healthcare Systems Inc.
3345 Michelson Ave., Suite 200, Irvine, Calif. 92715; 714-476-9816;
fax: 714-476-0650
Staff/Facilities
Primary practitioners4,507
Board-certified81%
Specialists11,752
Hospitals209
Pharmacies4,211
Users
Employees & dependents53,723
Total53,723Service Area: California: 31 cities.
See Private Healthcare Systems POS consolidated listing under Massachusetts.
Private Healthcare Systems
3345 Michelson Ave., Suite 200, Irvine, Calif. 92612; 714-476-9816; fax: 714-476-0650
Staff/Facilities
Primary practitioners15,946
Board-certified83%
Specialists17,465
Hospitals254
Pharmacies4,211
Users: Group Health
Employees & dependents287,907
Total Users287,907
Operational date: May 1987.
Service area: California: 34 cities and Orange County.
See Private Healthcare Systems PPO consolidated listing under Massachusetts.
Prudent Buyer Plan
21555 Oxnard St., Woodland Hills, Calif. 91367; 818-703-2345; fax: 818-703-2848
Staff/Facilities
Primary practitioners14,011
Board-certified71%
Patients/practitioner78
Specialists25,006
Hospitals391
Pharmacies4,683
Users: Group Health
Employer/payer groups1,920
Single coverage247,964
Family coverage209,815
Employees & dependents635,803
Total Users2,488,690
Ownership: WellPoint Health Networks.
Operational date: June 1983.
For profit.
Service area: California: 56 counties.
Contracts with Blue Cross & Blue Shield Assn. nationwide.
Services: General medical, mental health. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by employers/payers, insurers; charges flat fee per employee.
UR: Standard procedures excluding second surgical opinion. UR provided by the PPO.
Officers: Leonard Schaeffer, president/CEO-Wellpoint Health Networks; Ron Williams, president-Blue Cross of California Business; Rebecca Kapustay, senior vp-large group services; Dr. Michael Kaufman, senior vp/chief medical officer; Ferial Bahremand, vp-network development.
Contact: Ronald Ragland, 310-575-5400; Bill Flowers, 510-927-6181.
Prudential HealthCare HMO-Northern California
177 Bovet Road, Suite 400, San Mateo, Calif. 94402; 415-345-5599; fax: 415-377-1667
Staff/Facilities
Primary practitioners3,990
Board-certified78%
Patients/practitioner43
Specialists8,761
Hospitals113
Pharmacies917
Primary care locations306
Users
Employer/payer groups500
Employees & dependents84,114
Total84,114Operational date: July 1987.
Licensed in: California.
NCQA fully accredited.
Model type: Group, IPA.
Service area: California: 24 counties.
Services: General medical, dental, prescription drug, mental health. Services available unbundled.*
Officers: Cora Tellez, executive director; John Crooms, marketing director; Dr. Rene Vega, medical director; Diane Hied, case management; Kimberly Davis, provider relations.
Contact: John Crooms, 415-981-4493.
**General medical and dental only.
See Prudential HealthCare HMO consolidated listing under New Jersey.
Prudential HealthCare HMO-Southern California
5800 Canoga Ave., Woodland Hills, Calif. 91367; 800-433-3150; fax: 818-992-2514
Staff/Facilities
Primary practitioners5,120
Board-certified77%
Patients/practitioner61
Specialists12,457
Hospitals282
Pharmacies1,244
Primary care locations1,777
Users
Employer/payer groups1,080
Employees & dependents144,643
Medicare7,904
Total152,547Operational date: July 1987.
Licensed in: California.
NCQA fully accredited.
Model type: Group/IPA.
Service area: California: Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties.
Services: General medical, dental, prescription drug, mental health. Services available unbundled*.
Officers: Cora Tellez; executive director; Brad Burr, marketing director; Kimberly Davis, provider relations; Dr. Rene Vega, medical director; Diane Nied, case management.
Contact: Brad Burr, 818-610-6502.
**General medical and dental only.
See Prudential HealthCare HMO consolidated listing under New Jersey.
Prudential HealthCare POS-Northern California
177 Bovet Road, Suite 400, San Mateo, Calif. 94402; 415-345-5599; fax: 415-377-1667
Staff/Facilities
Primary practitioners3,990
Board-certified78%
Patients/practitioner43
Specialists8,760
Hospitals113
Pharmacies917
Primary care locations306
Users
Employer/payer groups596
Total88,700Operational date: July 1987.
Licensed in: California.
NCQA fully accredited.
Model type: Group/IPA.
Service area: California: 24 counties.
Services: General medical, dental, prescription drug, mental health. Services available unbundled*.
Officers: Cora Tellez, executive director; John Crooms, marketing director; Dr. Rene Vega, medical director; Diane Nied, case management; Kimberly Davis, provider relations.
Contact: John Crooms, 415-981-4493.
**General medical and dental only.
See Prudential HealthCare consolidated listing under New Jersey.
Prudential HealthCare POS-Southern California
5800 Canoga Ave., Woodland Hills, Calif. 91367; 800-433-3150; fax: 818-992-2514
Staff/Facilities
Primary practitioners5,100
Board-certified77%
Patients/practitioner61
Specialists12,452
Hospitals282
Pharmacies1,244
Primary care locations1,777
Users
Employer/payer groups1,163
Total151,987Operational date: July 1987.
Licensed in: California.
NCQA fully accredited.
Model type: Group/IPA.
Service area: California: Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties.
Services: General medical, dental, prescription drug, mental health. Services available unbundled*.
Officers: Cora Tellez, executive director; Brad Burr, marketing director; Kimberly Davis, provider relations; Dr. Rene Vega, medical director; Diane Nied, case management.
Contact: Brad Burr, 818-610-6502.
**General medical and dental only.
See Prudential HealthCare POS consolidated listing under New Jersey.
Prudential HealthCare PPO-Northern California
5800 Canoga Ave., Woodland Hills, Calif. 91367; 800-531-4112; fax: 818-992-2575
Staff/Facilities
Primary practitioners1,698
Board-certified77%
Specialists3,918
Hospitals6
Pharmacies917
Operational date: January 1991.
Service area: California: 29 counties.
Services: General medical, dental, prescription drug, mental health. Services available unbundled*.
Officers: Cora Tellez, executive director; John Crooms, marketing director; Dr. Rene Vega, medical director; Diane Nied, case management; Kimberly Davis, provider relations.
Contact: John Crooms, 415-981-4493
**General medical and dental only.
See Prudential HealthCare PPO consolidated listing under New Jersey.
Prudential HealthCare PPO-Southern California
5800 Canoga Ave., Woodland Hills, Calif. 91367; 800-531-4112; fax: 818-992-2575
Staff/Facilities
Primary practitioners1,327
Board-certified76%
Specialists3,305
Hospitals171
Pharmacies1,244
Operational date: January 1991.
Service area: California: Imperial, Inyo, Kern, Kings, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties.
Services: General medical, dental, prescription drug, mental health. Services available unbundled*.
Officers: Cora Tellez, executive director; Brad Burr, marketing director; Kimberly Davis, provider relations; Dr. Rene Vega, medical director; Diane Nied, case management.
Contact: Brad Burr, 818-610-6502.
**General medical and dental only.
See Prudential HealthCare PPO consolidated listing under New Jersey.