Georgia Gets a New Provider Network
February 3rd, 2009 Posted in Benefit Plan Design, Business Insurance, Health Insurance
Deborah Michael and I organized an informal breakfast meeting this morning between physician practice consultant, Mike Fleischman and insurance company executive, Don Weitzel. Oil and water under most circumstances, but productive in this setting.
To date Principal Life Insurance Company has rented the Private Healthcare Systems (PHCS) network of doctors and hospitals. While this has been a beneficial relationship one can see how owning your own network rather than renting one may produce some badly needed efficiencies.
Principal Edge, as the new network is called, will be installed as the default provider network for small- to medium-sized employer clients – it’s not a Medicare Advantage network! It is designed to be provider-focused and bring unique features to the doctor community. Don Weitzel, who is now the President of Principal Edge Network Georgia, is busy recruiting medical providers to the new panel. Principal hopes to have the new network in place in the last quarter of 2009.
Mike Fleischman, a principal with the consulting firm Gates Moore & Company, brought over twenty years of experience in provider / insurer contract negotiations to the table. Mike was able to represent the concerns of the provider community in that insurers must be more responsive in timeliness of payment and simplification of reimbursement schedules.
Principal Edge seems to accommodate these issues in its promise to pay providers within 15 calendar days (not work days). Failing to do so may result in a penalty being paid to the provider. Innovative thinking for an insurance company!
If there is a take-away for the doctor community it is to seriously consider signing up for this network. Like I said before, it is not another doomed Medicare Advantage plan asking for your time. Principal Life is a solid company that can bring thousands of paying patients to your door. And, you know the payor is Principal, not a nameless TPA tucked behind a rented network.
As an insurance agency we are looking forward to a more competitively priced medical plan to show our clients. Hopefully we can put a quote in front of you someday soon!