Wisconsin
AnciCare PPO
3700 Lakeside Drive, Suite 401, Miramar, Fla. 33027-3225; 800-414-4674; fax: 305-826-7482
Specialty: workers compensation/medical diagnostic imaging
Staff/Facilities
Primary practitioners2
Hospitals1
Service area: Wisconsin: Brown County.
See AnciCare PPO consolidated listing under Florida.
Associates for Health Care Inc.(AHC)
P.O. Box 981, Brookfield, Wis. 53008-0981; 800-952-8661 or 414-879-0100; fax: 414-879-0876
Staff/Facilities
Primary practitioners2,023
Board-certified100%
Specialists2,969
Hospitals98
Pharmacies44,000
Users: Group Health
Employer/payer groups5,300
Employees & dependents370,000
Users: Workers Compensation*
Employer/payer groupsNA
Single coverageNA
Operational date: September 1984.
For profit.
Service area: Minnesota: 36 counties; Wisconsin: statewide.
Services: General medical, dental, 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, providers, insurers; charges flat fee per employee, by percent of savings.
UR: Standard procedures excluding precertification, second surgical opinion and hospital bill audits. UR provided by the PPO.
Officers: Richard L. Blomquist, president/CEO; Tricia Price, vp-utilization management; Dr. Jacob Golding, medical director; David Dobias, senior vp-administration; Dirk Carson, vp-marketing.
Contact: Dirk Carson.
**Network released November 1, 1997. ***General medical, dental, vision and workers compensation only.
Blue Cross & Blue Shield of Wisconsin PPO
1515 N. RiverCenter Drive, Milwaukee, Wis. 53212; 414-226-6600
Staff/Facilities
Primary practitioners2,568
Board-certified74%
Patients/practitioner40
Specialists4,072
Hospitals88
Pharmacies1,100
Users
Single coverage18,063
Family coverage26,500
Employees & dependents103,776
Ownership: United Wisconsin Services Inc.
Operational date: 1984.
Not for profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: Wisconsin: 61 counties.
Contracts with Blue Cross & Blue Shield Assn. Blue Card PPO national network.
Services: General medical, prescription drug, mental health. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, percent discount off customary rates; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures excluding retrospective review, second surgical opinion, outpatient service predetermination, UR provided by the PPO.
Officers: Tom Hefty, CEO.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; 619-278-1262
Staff/Facilities
Primary practitioners964
Board-certified79.1%
Patients/practitioner301.4
Specialists1,355
Hospitals51
Users: Group Health
Employer/payer groups113
Employees & dependents16,003
Users: Workers Compensation
Employer/payer groups40
Total Users*16,003
Service area: Wisconsin: 47 counties.
Services: General medical, mental health, workers compensation, ancillary services.
**Does not include workers compensation users.
See CCN consolidated listing under California.
CNA Managed Care-LaCrosse
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1
Hospitals3
Service area: Wisconsin: LaCrosse.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Madison
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners405
Hospitals3
Service area: Wisconsin: Madison.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Milwaukee
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners2,234
Hospitals21
Service area: Wisconsin: Milwaukee.
See CNA Managed Care PPO consolidated listing under Illinois.
ChiroSource Inc.
P.O. Box 130, Clayton, Calif. 94517; 510-672-5333; fax: 510-672-6657
Specialty: chiropractic
Staff/Facilities
Primary practitioners26
Service area: Wisconsin: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA Managed Care Network of Wisconsin
275 N. Corporate Drive, Suite 120, Brookfield, Wis. 53045; 414-792-2658; fax: 414-792-9278
Staff/Facilities
Primary practitioners737
Board-certified73.4%
Patients/practitioner28
Specialists1,429
Hospitals24
Pharmacies419
Users
Employer/payer groups208
Total20,655Operational date: January 1992.
Licensed in: Wisconsin.
Model type: IPA.
Service area: Wisconsin: Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha counties.
Point-of-service contracts: 75.2% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Bert Wagener, general manager; Pam Hays, executive director; Richard Balsamo, medical director; Dan O'Connell, sales director/market manager; Jim Watson, planning/analysis medical economics.
Contact: Pam Hays.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
Compcare Health Services
401 W. Michigan St., Milwaukee, Wis. 53203; 414-226-6600
Staff/Facilities
Primary practitioners1,451
Board-certified73%
Patients/practitioner103
Specialists2,930
Hospitals44
Pharmacies1,100
Users
Single coverage19,040
Family coverage31,315
Employees & dependents125,887
Medicare6,029
Medicaid33,483
Total150,246
Revenues
First-half 1997$153,091,533
1996$269,543,849Parent: United Wisconsin Services Inc.
Operational date: May 1971.
Federally qualified.
Licensed in: Wisconsin.
Model type: Group/IPA/Network.
For profit.
Service area: Wisconsin: 25 counties. Member of Blue Cross & Blue Shield Assn. HMO USA program.
Services: General medical, dental, vision, prescription drug, mental health, chiropractic. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 20% of members are enrolled.
Non-federally qualified programs.
Officers: Tom Hefty, CEO.
CorVel Corp.
1920 Main St., Suite 1090, Irvine, Calif. 92714; 714-851-1473; fax: 714-851-1469
Staff/Facilities
Primary practitioners410
Board-certified97%
Specialists2,458*
Hospitals41
Service area: Wisconsin.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
Delta Dental Plan of Wisconsin-DeltaCare
P.O. Box 828 Stevens Point, Wis. 54481; 715-344-6087; fax: 715-344-9058
Specialty: dental
Staff/Facilities
Primary practitioners93
Board-certified100%
Specialists23
Users
Employer/payer groups63
Single coverage1,066
Family coverage1,228
Employees & dependents5,940
Total5,940
Revenues
First-half 1997*$150,262
1996$23,037Operational date: May 1994.
Licensed in: Wisconsin.
Model type: Network.
Not for profit.
Service area: Wisconsin: Dane, Jefferson, Kenosha, Milwaukee, Outagamie, Ozaukee, Racine, Rock, Washington and Waukesha counties.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Officers: Gary Rogers, vp-marketing; Dennis Peterson, executive vp; Patty Glennon, vp-finance; Karen Johnson, vp-operations; Karen Thompson, vp-underwriting/actuarial.
Contact: Gary Rogers, 800-236-3713.
**As of 9/97.
Delta Dental Plan of WisconsinDeltaPreferred Option
P.O. Box 828, Stevens Point, Wis. 54481; 715-344-6087; fax: 715-344-9058
Specialty: dental
Staff/Facilities
Primary practitioners530
Specialists125
Users: Group Health
Employer/payer groups104
Single coverage13,000
Family coverage15,074
Employees & dependents78,734
Ownership: Delta Dental Plan of Wisconsin Inc.
Operational date: January 1991.
Not for profit.
Service area: Wisconsin: 33 counties.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates charges by discount off customary rates; is compensated by employers/payers; charges are incorporated into group premium.
UR: Credentialing, predetermination, quality assurance. UR provided by the PPO.
Officers: Gary Rogers, vp-marketing; Dennis Peterson, executive vp; Patty Glennon, vp-finance; Karen Johnson, vp-operations; Karen Thompson, vp-underwriting/actuarial.
Contact: Gary Rogers, 800-236-3713.
FOCUS Healthcare Management Inc.
7101 Executive Center Drive, Suite 375, Brentwood, Tenn. 37207; 800-873-0055 or 615-377-9936; fax: 615-661-4042
Specialty: workers compensation
Staff/Facilities*
Primary practitioners353
Specialists1,592
Hospitals25
Total Users33,815
Operational date: April 1990.
Service area: Wisconsin: 50 counties.
**Includes leased providers/facilities.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*881
Specialists1,415
Hospitals**30
Service area: Wisconsin: 59 counties.
**Includes some specialists. ***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
HealthStar Inc.
8745 W. Higgins Road, Suite 300, Chicago, Ill. 60631; 773-693-7827; 773-693-7907
Staff/Facilities
Primary practitioners 147
Specialists275
Hospitals24
Operational date: 1996.
Service area: Wisconsin: Chippewa, Eau Claire, Fond du Lac, Green, Kenosha, Milwaukee, Ozaukee, Polk and Waukesha counties.
See HealthStar Inc. consolidated listing under Illinois.