PPO Network Management
AlaMed is an Alabama PPO. It is the largest work comp PPO in the state of Alabama. The only other health care insurance provider in Alabama bigger than AlaMed is Blue Cross/Blue Shield. Back in 1993 we had to pay the billed charges from a medical doctor but we have one right that makes us different from any other state in the United States: the employer gets to direct the employee to a particular doctor or hospital or facility who will treat his work comp injuries. Because we have that right, we can then choose that doctor or clinic or hospitals business. We know we can send hospitals or doctors or other facilities business, so we go to the table carrying 80% of the work comp market to negotiate with. That gives us large front end discounts that are extremely deep and far greater than the state fee schedule and far greater than any other medical bill repricing company. The reason is because all the other medical repricing companies do not handle and administer the claims. Therefore they can’t promise their hospitals any business and so they’re referred to as rear end repricing contract holders and they get small discounts. Our discounts in AlaMed are substantial and if you are a member or an account of one of four TPAs in the state of Alabama you obtain these huge discounts for free. You do not have to pay a percentage of savings when you get these contracts applied to your medical bills. These are 100% given to you from our contract price which means that we literally pay for our services and then we make our accounts money by that one fact -you get these discounts for free.
Health Choice is a provider-sponsored Preferred Provider Organization (PPO) network. We offer a statewide network of physician, hospital and ancillary medical providers to employers as well as payer organizations. Because it is sponsored by medical providers, Health Choice seeks to offer an alternative delivery system to groups at preferred rates in return for steered volume to our network provider members. Health Choice has been in operation since 1984. The network began in Birmingham with a limited number of hospital and physician participants. The network has grown to include over 90 hospital locations, over 6,200 physicians and over 750 ancillary providers.