North Carolina
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 practitioners4
Hospitals2
Service area: North Carolina: Guilford and Pitt counties.
See AnciCare PPO consolidated listing under Florida.
Beech Street Corp.
173 Technology, Irvine, Calif. 92618; 800-233-2478 or 714-727-1353; fax: 714-727-1319
Staff/Facilities
Primary practitioners277
Specialists1,311
Hospitals44
Users: Group Health
Single coverage20,559
Family coverage80,450
Employees & dependents205,595
Users: Workers Compensation
Single coverage2,128
Total Users207,723
Operational date: 1987.
Service area: North Carolina: 79 counties.
See Beech Street Corp. consolidated listing under California.
Berkley Care Network Inc.
5-E Oak Branch Drive, Greensboro, N.C. 27407; 800-668-2996; fax: 910-856-0116
Specialty: workers comp
Staff/Facilities
Primary practitioners352
Board-certified96%
Specialists1,930
Hospitals33
Users: Workers Compensation
Employer/payer groups8
Single coverage70,840
Total Users70,840
Operational date: February 1994.
For profit.
Service area: Connecticut: statewide.
Contracts with FOCUS Healthcare Management for general services and workers compensation in Colorado, Kansas, Minnesota, Montana, Pennsylvania, South Dakota and Texas; Preferred Health Network for workers compensation in Illinois, Iowa, Nebraska and Wisconsin.
Services: Workers compensation. 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, insurers; charges flat fee per employee, by percent of savings, fee-for-service, hourly service fees, risk sharing.
UR: Standard procedures excluding length of stay determination. UR provided by the PPO.
Officers: Robert Steciak, president; Dr. Peter Amato, medical director; Paula Heverling, director-operations; Christine Anderson, provider relations manager.
Contact: Robert Steciak.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; 619-278-1262
Staff/Facilities
Primary practitioners1,046
Specialists2,717
Hospitals74
Service area: North Carolina: 86 counties.
Services: General medical, mental health, workers compensation, ancillary services.
See CCN consolidated listing under California.
CNA Managed Care-Charlotte/
Winston-Salem
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners2,643
Hospitals39
Service area: North Carolina: Charlotte/Winston-Salem.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Raleigh/Durham
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners2,225
Hospitals20
Service area: North Carolina: Raleigh/Durham.
See CNA Managed Care PPO consolidated listing under Illinois.
CAPP CARE Inc.
West Tower, 4000 MacArthur Blvd., Suite 10000, Newport Beach, Calif. 92660; 800-937-2277; fax: 714-251-2222
Staff/Facilities
Primary practitioners*444
Board-certified61.4%
Patients/practitioner51.8
Hospitals14
Service area: North Carolina: 32 counties.
**Includes specialists.
See CAPP CARE Inc. consolidated listing under California.
ChiroSource Inc.
P.O. Box 130, Clayton, Calif. 94517; 510-672-5333; fax: 510-672-6657
Specialty: chiropractic
Staff/Facilities
Primary practitioners34
Service area: North Carolina: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA HealthCare of North Carolina Inc.-Charlotte
11121 Carmel Commons Blvd., Suite 300A, Charlotte, N.C. 28226; 704-544-4350; 704-544-4375
Staff/Facilities
Primary practitioners497
Board-certified86.1%
Patients/practitioner134
Specialists1,109
Hospitals19
Pharmacies534
Users
Employer/payer groups586
Total66,627Operational date: January 1992.
Licensed in: North Carolina.
Model type: IPA.
Service area: North Carolina: Buncombe, Burke, Cabarrus, Caldwell, Catawba, Gaston, Henderson, Iredell, Lincoln, McDowell, Mecklenburg, Rowan, Stanly and Union counties.
Point-of-service contracts: 56.3% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: John Fetch, assistant vp-network management/provider relations manager; Bob Greczyn, executive director/general manager; Dr. Virginia Hemelt, medical director; Margie Maxwell, sales director/market manager; Mark Gordon, director/manager-operations.
Contact: Tammie Harrell.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA HealthCare of North Carolina Inc.-Raleigh
4011 Westchase Blvd., Suite 290, Raleigh, N.C. 27607; 919-839-7800; 919-839-7888
Staff/Facilities
Primary practitioners607
Board-certified86.2%
Patients/practitioner72.3
Specialists1,030
Hospitals24
Pharmacies895
Users
Employer/payer groups428
Total43,918Operational date: January 1986.
Licensed in: North Carolina.
Model type: IPA.
Service area: North Carolina: 21 counties.
Point-of-service contracts: 59.9% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: John Fletch, assistant vp-network development; Bob Greczyn, executive director/general manager; Dr. Virginia Hemelt, medical director; Margie Maxwell, sales director/market manager; Mark Gordon, director/manager-operations .
Contact: Tammie Harrell.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Charlotte
11121 Carmel Commons, Suite 300A, Charlotte, N.C. 28226; 704-544-4350; 704-544-4375
Staff/Facilities
Primary practitioners512
Board-certified85.9%
Patients/practitioner63.2
Specialists1,321
Hospitals20
Users: Group Health
Employer/payer groups341
Total Users32,377
Operational date: October 1989.
Service area: North Carolina: Buncombe, Burke, Cabarrus, Caldwell, Catawba, Gaston, Henderson, Iredell, Lincoln, McDowell, Mecklenburg, Rowan, Stanly and Union counties.
Officers: Bob Greczyn, executive director/general manager; Mark Gordon, director/manager-operations; Dr. Virginia Hemelt, medical director; Margie Maxwell, sales director/market manager; John Fletch, provider relations manager.
Contact: Kathleen Gillanders, 860-726-5784.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Raleigh
4011 Westchase Blvd., Suite 290, Raleigh, N.C. 27607; 919-839-7800; 919-839-7888
Staff/Facilities
Primary practitioners570
Board-certified86.1%
Patients/practitioner54.2
Specialists1,167
Hospitals33
Users: Group Health
Employer/payer groups349
Total Users30,912
Operational date: June 1989.
Service area: North Carolina: Alamance, Brunswick, Chatham, Cumberland, Durham, Edgecombe, Forsyth, Franklin, Guilford, Harnett, Hoke, Johnston, Lee, Nash, New Hanover, Orange, Pender, Pitt, Randolph, Wake and Wilson counties.
Officers: Bob Greczyn, executive director/general manager; Mark Gordon, director/manager-operations; Dr. Virginia Hemelt, medical director; Margie Maxwell, sales director/market manager; John Fletch, provider relations manager.
Contact: Kathleen Gillanders, 860-726-5784.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CorVel Corp.
1920 Main St., Suite 1090, Irvine, Calif. 92714; 714-851-1473; fax: 714-851-1469
Staff/Facilities
Primary practitioners705
Board-certified95%
Specialists5,358*
Hospitals47
Service area: North Carolina.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
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 practitioners556
Specialists3,086
Hospitals32
Total Users504,338
Operational date: June 1991.
Service area: North Carolina: 80 counties.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
Guardian Resources Inc.
2739 U.S. Highway 19 N., Suite 350, Holiday, Fla. 34691; 813-938-2222; 813-938-2880
Staff/Facilities
Primary practitioners557
Board-certified55%
Specialists1,811
Hospitals47
Users: Group Health
Employer/payer groups21
Single coverage4,200
Family coverage3,500
Employees & dependents11,900
Total Users11,900
Service area: North Carolina: statewide.
See Guardian Resources consolidated listing under Florida.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*536
Specialists1,445
Hospitals**34
Service area: North Carolina: 90 counties.
**Includes some specialists. ***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
Health Care Savings Inc.*
4530 Park Road, Suite 110, Charlotte, N.C. 28209; 800-833-8464;
fax: 704-527-0677
Staff/Facilities
Primary practitioners3,033
Board-certified80%
Patients/practitioner37
Specialists5,214
Hospitals101
Users: Group Health
Employer/payer groups18,576
Employees & dependents262,345
Total Users262,345
Ownership: Carolina Doctors Care.
Operational date: January 1985.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards. Service area: North Carolina and South Carolina: statewide; Virginia: Greensville County.
Contracts with ProAmerica for general services in North and South Carolina.
Services: General medical. 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; charges flat fee per employee, by percent of savings.
UR: Standard procedures.
UR provided by the PPO.
Officers: Dr. Lawrence Cutchin, CEO/medical director; David Pate, CFO; Gary Lewis, COO; Robert Parr, vp; Dr. Kevin Soden, associate medical director.
Contact: Amy Moellenkamp, director-sales/marketing.
**Figures are consolidated, including all PPO plans in this organization.
Health Care Savings Inc.
4530 Park Road, Suite 110, Charlotte, N.C. 28209; 800-833-8464;
fax: 704-527-0677
Staff/Facilities
Primary practitioners2,176
Patients/practitioner40
Specialists3,958
Hospitals65
Users: Group Health
Employer/payer groups13,390
Employees & dependents201,250
Total Users201,250
Service area: North Carolina: 74 counties.
See Health Care Savings Inc. consolidated listing under North Carolina.
Healthsource North Carolina Inc.*
701 Corporate Center Drive, Raleigh, N.C. 27607; 919-854-7000;
fax: 919-854-7103
Staff/Facilities
Primary practitioners3,669
Board-certified80.5%
Specialists4,525
Hospitals69
Pharmacies1,400
Primary care locations2,619
Users
Employer/payer groups946
Single coverage50,182
Family coverage55,738
Employees & dependents224,247
Total224,247
Revenues
First-half 1997$168,672,391
1996$278,222,073Parent: CIGNA HealthCare*.
Operational date: April 1986.
Licensed in: North Carolina.
NCQA one year accredited.
Model type: IPA.
For profit.
Service area: North Carolina: 59 counties.
Services: General medical, vision, prescription drug, mental health/substance abuse. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class.
Offers self-insured products.
Point-of-service contracts: 28% of members are enrolled.
Officers: Robert J. Greczyn Jr., president/CEO; Sabin C, Bass, vp/CFO; Dr. Robert T. Harris, senior vp-medical management; Maureen K. O'Connor, senior vp-corporate development/legal affairs; Ellen M. Tucker, senior vp-underwriting/development.
Contact: Ellen M Tucker.
**Healthsource Inc. was acquired by CIGNA HealthCare in June 1997.
HealthsourceProvident*
6101 Carnegie Blvd., Suite 400, Charlotte, N.C. 28209; 704-556-5400;
fax: 704-556-5840
Staff/Facilities
Primary practitioners2,634
Board-certified75%
Specialists5,303
Hospitals107
Pharmacies1,615
Total Users**314,990
Ownership: CIGNA HealthCare*.
Operational date: October 1983.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: North Carolina: 87 counties.
Services: General medical, prescription drug, mental health. 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 insurers; charges flat fee per employee.
UR: Standard procedures excluding retrospective review and second surgical opinion. UR provided by the PPO.
Officers: James Pesnell, CEO; Dave Kemmerer, Jerry Wheeler, Ron Schenck, Tim Klopfenstein, vps.
Contact: Pam Conway, 423-755-3288.
**Healthsource Inc. was acquired by CIGNA HealthCare in June 1997. ***Includes enrollment for Georgia, North Carolina, South Carolina, Tennessee.
HealthStar Inc.
5108 N. I-85 Service Road, Suite 14, Charlotte, N.C. 28206; 704-597-7001; fax: 704-597-1429
Staff/Facilities
Primary practitioners1,231
Specialists2,287
Hospitals90
Users: Group Health
Employees & dependents102,915
Total Users102,915
Operational date: 1991.
Service area: North Carolina: statewide.
See HealthStar Inc. consolidated listing under Illinois.
Kaiser Foundation Health Plan of North Carolina
3120 Highwoods Blvd., Raleigh, N.C. 27604; 919-981-6000; fax: 919-981-6052
Staff/Facilities
Primary practitioners543
Board-certified91%
Patients/practitioner253
Specialists2,138
Hospitals11
Pharmacies959
Primary care locations98
Users
Employer/payer groups2,839
Single coverage41,486
Family coverage32,033
Employees & dependents127,757
Medicare2,495
Medicaid6,108
Total136,360
Revenues
First-half 1997$99,903,654
1996$192,359,136Operational date: January 1984.
Federally qualified.
Licensed in: North Carolina, South Carolina.
NCQA fully accredited.
Model type: Mixed.
Not for profit.
Service area: North Carolina: 21 counties; South Carolina: Chester, Lancaster and York counties.
Services: General medical, vision, prescription drug, mental health, durable medical equipment, hospitalization, lab, x-ray, preventive medicine, health education, substance abuse. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 2.6% of members are enrolled.
Non-federally qualified programs.
Officers: Chris Binkley, president-KFHP of the Southwest; Dr. Peter H. Lee, executive medical director; Carol Roecklin, executive director-Central Carolinas; George Stokes, executive director-triangle; W. Dewey Brown, vp-finance.
Contact: Myra Joines, 704-551-1956.
See Kaiser Permanente consolidated listing under California.