Ohio
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 practitioners24
Hospitals18
Service area: Ohio: Cuyahoga, Jefferson, Lake, Mahoning, Montgomery and Trumbull 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 practitioners3,121
Specialists11,217
Hospitals114
Users: Group Health
Single coverage35,615
Family coverage125,285
Employees & dependents323,771
Users: Workers Compensation
Single coverage13,833
Total Users337,605
Operational date: 1988.
Service area: Ohio: 84 counties.
See Beech Street Corp. consolidated listing under California.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; 619-278-1262
Staff/Facilities
Primary practitioners5,883
Specialists9,622
Hospitals122
Service area: Ohio: 84 counties.
Services: General medical, mental health, workers compensation, ancillary services.
See CCN consolidated listing under California.
CNA Managed Care-Cincinnati
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Primary practitioners282
Specialists385
Hospitals19
Primary care locations25Service area: Ohio: Cincinnati.
See CNA Managed Care POS consolidated listing under Illinois.
CNA Managed Care-Akron
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners2,058
Hospitals21
Service area: Ohio: Akron.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Cincinnati
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners3,026
Hospitals21
Service area: Ohio: Cincinnati.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Cleveland
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners3,579
Hospitals40
Service area: Ohio: Cleveland.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Columbus
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners2,554
Hospitals34
Service area: Ohio: Columbus.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Dayton
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,342
Hospitals10
Service area: Ohio: Dayton.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Toledo
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,137
Hospitals13
Service area: Ohio: Toledo.
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 practitioners57
Service area: Ohio: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA HealthCare of Ohio Inc.-Cincinnati
600 Vine St., Suite 602, Cincinnati, Ohio 45202; 513-629-2640; fax: 513-629-2639
Staff/Facilities
Primary practitioners1,043
Board-certified77.3%
Patients/practitioner29.1
Specialists1,739
Hospitals30
Pharmacies702
Users
Employer/payer groups369
Total30,413Operational date: January 1992.
Licensed in: Ohio.
Model type: IPA.
Service area: Kentucky: Boone, Campbell, Grant and Kenton counties; Ohio: Allen, Auglaize, Butler, Clark, Clermont, Greene, Hamilton, Miami, Montgomery, Shelby and Warren counties.
Point-of-service contracts: 52.5% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: James D. Massie, general manager; Dr. William Jantsch, medical director; Marybeth Elkamp, director/manager-operations/provider relations manager; Joanne Jeanquenat, quality assurance manager; Krista Ball, UM health services manager.
Contact: Lana Feeback.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA HealthCare of Ohio Inc.-Cleveland
5005 Rockside Road, Suite 700, Cleveland, Ohio 44131; 216-642-2920; fax: 216-642-2990
Staff/Facilities
Primary practitioners648
Board-certified78%
Patients/practitioner75.7
Specialists1,367
Hospitals37
Pharmacies967
Users
Employer/payer groups925
Total49,101Operational date: April 1987.
Licensed in: Ohio.
NCQA fully accredited.
Model type: IPA.
Service area: Ohio: Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull and Wayne counties.
Point-of-service contracts: 64.5% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Jeanne McCarthy, general manager/executive director; Dr. Jennifer Harper, medical director; Vera Papalko, provider relations manager; Marilyn Spitaleri, quality assurance manager; Cathy Eck, UM health services manager.
Contact: Diane Brown.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA HealthCare of Ohio Inc.-Columbus
3700 Corporate Drive, N.E. Business Campus, Suite 5, Columbus, Ohio 43231; 614-823-7500; fax: 614-823-7519
Staff/Facilities
Primary practitioners509
Board-certified71.8%
Patients/practitioner120.3
Specialists1,024
Hospitals34
Pharmacies431
Users
Employer/payer groups356
Total61,237Operational date: May 1987.
Licensed in: Ohio.
NCQA fully accredited.
Model type: IPA.
Service area: Ohio: Champaign, Coshocton, Delaware, Fairfield, Fayette, Franklin, Licking, Madison, Muskingum, Perry, Pickaway, Ross, Tuscarawas and Union counties.
Point-of-service contracts: 62.8% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: James D. Massie, general manager; Dr. William Jantsch, medical director; Mark Richardson, director/manager-operations; Carol Tinnel, provider relations manager; P. Steven Keller, sales director/manager.
Contact: Brett C. Rankin.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA Managed Care Network of West Virginia/Southeast Ohio
5005 Rockside Road, Suite 700, Cleveland, Ohio 44131; 216-642-2920; fax: 216-642-2990
Staff/Facilities
Primary practitioners289
Board-certified64%
Patients/practitioner72.8
Specialists477
Hospitals21
Pharmacies175
Users
Employer/payer groups216
Total21,052Operational date: January 1994.
Licensed in: Ohio, West Virginia.
Model type: IPA.
Service area: Ohio: Athens, Belmont, Meigs, Noble and Washington counties; West Virginia: Boone, Fayette, Harrison, Jackson, Kanawha, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Putnam, Raleigh, Ritchie, Roane, Tyler, Wetzel, Wirt and Wood counties.
Point-of-service contracts: 70% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Ron Dziedzicki, director/manager-operations/regional contracting officer; Dr. Jennifer Harper, medical director; Dr. David Cogan, associate medical director; Marilyn Spitaleri, quality assurance manager; Kathy Eck, UM heath services manager.
Contact: Kathy Oplingel.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA Managed Care Network of Willard
5005 Rockside Road, Suite 700, Cleveland, Ohio 44131; 216-642-2920; fax: 216-642-2990
Staff/Facilities
Primary practitioners45
Board-certified62%
Patients/practitioner69.5
Specialists76
Hospitals5
Pharmacies1,573
Users
Employer/payer groups3
Total3,128Operational date: January 1996.
Licensed in: Ohio.
Model type: IPA.
Service area: Ohio: Crawford, Huron and Richland counties.
Point-of-service contracts: 100% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Jeanne McCarthy, general manager/executive director; Dr. Jannifer Harper, medical director; Vera Papalko, provider relations manager; Carl Biats, sales/director/market manager; Cathy Eck, UM health services manager.
Contact: Diane Brown.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Cincinnati/
Dayton
600 Vine St., Suite 602, Cincinnati, Ohio 45202; 513-629-2640; fax: 513-629-2639
Staff/Facilities
Primary practitioners1,066
Board-certified77.5%
Patients/practitioner24.8
Specialists1,924
Hospitals33
Users: Group Health
Employer/payer groups364
Total Users26,488
Operational date: February 1990.
Service area: Ohio: Allen, Auglaize, Boone, Butler, Campbell, Clark, Clermont, Grant, Greene, Hamilton, Kenton, Miami, Montgomery, Shelby and Warren counties.
Officers: James D. Massie, general manager; Dr. William Jantsch, medical director; Marybeth Elkamp, director/manager-operations/provider relations manager; Steven Keller, sales director/manager.
Contact: Andrew Green, 860-726-3586.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Cleveland/Akron
5005 Rockside Road, Suite 700, Cleveland, Ohio 44131; 216-642-2920; fax: 216-642-2990
Staff/Facilities
Primary practitioners1,464
Board-certified78.8%
Patients/practitioner27.5
Specialists3,404
Hospitals60
Users: Group Health
Employer/payer groups345
Total Users40,300
Operational date: August 1987.
Service area: Ohio: Ashland, Ashtabula, Carroll, Columbiana, Cuyahoga, Erie, Geauga, Huron, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas and Wayne counties.
Officers: Jeane McCarthy, executive director/general manager; Dr. Jannifer Harper, medical director; Carl Biats, sales director/manager; Vera Papalko, provider relations manager; Cheryl Colles, planning/analysis-medical economics.
Contact: Andrew Green, 860-726-3586.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Columbus
3700 Corporate Drive, N.E. Business Campus, Suite 5, Columbus, Ohio 43231; 614-823-7500; fax: 614-823-7519
Staff/Facilities
Primary practitioners709
Board-certified71.5%
Patients/practitioner72.3
Specialists1,268
Hospitals43
Users: Group Health
Employer/payer groups290
Total Users51,282
Operational date: January 1991.
Service area: Ohio: 25 counties.
Officers: James D. Massie, general manager; Mark Richardson, director/manager-operations; Dr. William Jantsch, medical director; Steven Keller, sales director/manager; Carol Tinnel, provider relations manager.
Contact: Andrew Green, 860-726-3586.
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 practitioners4,755
Board-certified85%
Specialists12,106*
Hospitals212
Service area: Ohio.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
Delta Dental Plan of Ohio Inc.-DeltaCare
P.O. Box 29979, Columbus, Ohio 43229-0979; 800-537-5527 or 614-890-1117; fax: 614-890-1274
Specialty: dental
Staff/Facilities
Primary practitioners108
Board-certified100%
Patients/practitioner.0.5
Specialists25
Primary care locations*49
Users
Employer/payer groups4
Single coverage19
Family coverage33
Employees & dependents129
Medicare1,845
Total1,974
Revenues
First-half 1997$5,028
Parent: Delta Dental Plan of Michigan Inc.
Operational date: 1997.
Licensed in: Ohio.
Model type: Network.
Not for profit.
Service area: Ohio, statewide.
Services: Dental. Services available unbundled.May be customized to meet employer specifications.
Rating options: Community rating by class.
Officers: C. Richard Seitz, president/CEO; Dr. Thomas J. Fleszar, executive vp/COO; Katherine K. Downer, vp-professional relations/inquiry services; E. Craig Lesley, vp-marketing; Thomas B. Dixson, vp-administration.
Contact: Tom DeNoma.
**Reflects total offices.
Delta Dental Plan of Ohio Inc.-DeltaPreferred Option
P.O. Box 29979, Columbus, Ohio 43229-0979; 800-537-5527 or 614-890-1117; fax: 614-890-1274
Specialty: dental
Staff/Facilities
Primary practitioners619
Board-certified100%
Specialists152
Users: Group Health
Employer/payer groups39
Single coverage10,320
Family coverage6,960
Employees & dependents39,795
Total Users39,795
Ownership: Delta Dental Plan of Michigan Inc.
Operational date: February 1994.
Not for profit.
Service area: Ohio: statewide.
Services: Dental. Services available unbundled. May be customized to meet employer specifications.
Compensation: Is compensated by employers/payers, TPAs; charges flat fee per employee.
UR: Precertification, case management, cost management. UR provided by the PPO.
Officers: C. Richard Seitz, president/CEO; Dr. Thomas J. Fleszar, executive vp/COO; Katherine K. Downer, vp-professional relations/inquiry services; E. Craig Lesley, vp-marketing; Thomas B. Dixson, vp-administration.
Contact: Tom DeNoma.
DirectCare America Inc.
4301 Darrow Road, Stow, Ohio 44224; 330-686-7030; fax: 330-686-7031
Staff/Facilities
Primary practitioners6,542
Board-certified85%
Specialists11,817
Hospitals202
Pharmacies40,000
Users: Group Health
Employer/payer groups153
Employees & dependents1,500,000
Total Users1,500,000
Ownership: The Chandler Group of Cos.
Operational date: February 1995.
For profit.
Service area: Nationwide.
Services: General medical, prescription drug, mental health, workers compensation. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; 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: Arthur W. Chandler, chairman; James K. Piper, president; Burton Margolis, CFO; Cindy Craig, vp-operations; Dr. Robert C. Erwin Jr., medical director.
Contact: James K. Piper.
Emerald HMO Inc.
1100 Superior Ave., 16th Floor, Diamond Building, Cleveland, Ohio 44114; 216-479-2030; fax: 216-479-2014
Staff/Facilities
Primary practitioners1,300
Board-certified80%
Specialists3,100
Hospitals29
Pharmacies500
Primary care locations1,700
Users
Employer/payer groups650
Employees & dependents21,000
Medicare1,600
Medicaid6,000
Total28,600
Revenues
First-half 1997$20,553,233Parent: Emerald Health.
Operational date: January 1995.
Licensed in: Ohio.
Model type: Group/IPA.
For profit.
Service area: Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Stark and Summit counties.
Contracts with CMG Health Inc. for mental health; Cole Vision for vision; Rx America for prescription drug.
Services: General medical, vision, prescription drug, mental health.
Rating options: Community rating by class.
Offers self-insured products.
Point-of-service contracts: 1% of members are enrolled.
Officers: Burt Bungus, CEO; Susan Simoson, COO; Chuck Schneider, president; Kip Stretton, vp-marketing; Dr. Burton Pomerantz, medical director; Jim Spear, CFO.
Contact: Emerald Service Center, 800-522-2416.
The Emerald Health Network Inc.
1100 Superior Ave., 16th Floor, Diamond Building, Cleveland, Ohio 44114; 216-479-2030; fax: 216-479-2014
Staff/Facilities
Primary practitioners3,500
Board-certified70%
Specialists5,500
Hospitals106
Users: Group Health
Employer/payer groups3,000
Employees & dependents325,000
Ownership: Emerald Health.
Operational date: September 1983.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards, Health Network Standards.
Service area: Indiana: 40 counties; Kentucky: 25 counties; Ohio: 88 counties; Pennsylvania: Allegheny, Beaver, Butler, Crawford, Erie, Lawrence, Mercer and Washington counties.
Services: General medical, vision, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, providers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures excluding hospital bill audits. UR provided by the PPO.
Officers: Burt Bungus, CEO; Susan Simoson, COO; Chuck Schneider, president; Kip Stretton, vp-marketing; Dr. Burton Pomerantz, medical director; Jim Spear, CFO.
Contact: Emerald Service Center, 800-683-6830.
Emerald Premier by Emerald HMO
1100 Superior Ave., 16th Floor, Diamond Building, Cleveland, Ohio 44114; 216-479-2030; fax: 216-479-2014
Staff/Facilities
Primary practitioners950
Board-certified80%
Hospitals17
Pharmacies500
Primary care locations1,600
Users
Employer/payer groups5
Employees & dependents190
Medicare1,600
Medicaid6,000
Total7,790Parent: Emerald Health.
Operational date: June 1997.
Licensed in: Ohio.
Model type: Group/IPA.
For profit.
Service area: Ohio: Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Stark and Summit counties.
Contracts with CMG Health Inc. for mental health; Cole Vision for vision; Rx America for prescription drug.
Services: General medical, vision, prescription drug, mental health.
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. Individual enrollment is allowed.
Officers: Burt Bungus, CEO; Susan Simoson, COO; Chuck Schneider, president; Kip Stretton, vp-marketing; Dr. Burton Pomerantz, medical director; Jim Spear, CFO.
Contact: Emerald Service Center, 800-522-2416.