SPECIAL OFFER -
All HEALTH NET members are eligible for a 10% discount off the total price of their bill at Portobello Restaurant, John and Fair Sts. in Kingston, for dining from Monday through Thursday.
Members must show their HEALTH NET card and one other form of identification to receive the discount. There is a maximum of 4 in the party and the bill must be paid by the HEALTH NET cardholder.
THIS OFFER IS ONLY OPEN TO HEALTH NET MEMBERS.
Submit all claims to:
Physicians Management Network, Inc.
P.O. Box 1008
Elmira, New York 14902-1008
You may now call Miriam Longendyke at 338-5422 with any Kingston Trust Fund questions.
Board of Trustees - 1999-2000:
Terry Brasky
Sandy Carlson
Greg Gerard - Treasurer
Doug Goodemote
Lindsay Orr - Secretary
Stu Spoljaric - Chairman
Claire Van Valkenburgh
October, 1999 - REPORT FROM THE PRESIDENT: (a letter from Joseph Fiegoli)
I am proud to report to the Trustees of the Kingston Trust Fund that 1999 has proven to be another successful year. 95.6% of the total membership are successfully using in Network physicians and facilities, which has contributed greatly to the financial success in 1999. Our specific claims threshold was only invaded once during the year 1998-1999. Our Utilization Review and Precertification programs have proven to be an astounding success, and through the management of these programs virtually hundreds of thousands of dollars have been saved.
Our Large Case Management department has successfully monitored and negotiated fees for the benefit of the Fund and its members, without minimizing or deluding critical medical services. Claims adjudication during 1999 has reached my expectations and predictions. Claims are adjudicated and paid within 7-11 days from date of receipt. Our accuracy percentage as audited by an outside auditor has reported a 94.5% accuracy rating. Member communications has improved immensely in the year 1999 through the strong efforts of our claims department personnel. Actual telephone waiting time is no longer than 4 minutes. Return calls to members are no longer than 48 hours. Questions are answered immediagtely if information is available.
Our Mental Health and Substance Abuse Department, in the year 1999 has amassed a savings of well over 49% of incurred charges. Their coordination with our Utilization and Large Case Management Department has proved to be a successful combination. Our PPO Network within this area has grown to well over 300 psychiatrists, 180 psychologists and over 50 outreach centers, at substantial contractual savings to the Trust and its members. This department is constantly growing, and the year 2000 should again prove to be as successful as this year.
Like all major companies, there are department heads that are never seen by the clients we serve. Our Reinsurance Department is certainly a good example of this statement. The financial protection of the plan is monitored each month by this department, and reports directly to the Actuarial office and my office when trends that are detrimental to the plan and its financial well being are tracked. The ultimate goal of this department is to succesfully negotiate with reinsurance companies for the benefit of the plan. 1999, based on the historical record has produced a reduction of premium for the year 2000.
The formation of our Compliance Department in 1999 is another example of a true success. This department answers all inquiries regarding plan interpretation, disputes of claim payments, and answers all questions regarding the laws that govern the plan. In addition, the actuarial sub-department is responsible directly to me in producing the necessary financial and trend reports both internally and externally in the plan year. This department is also responsible to make recommendations in plan changes and design, and to coordinate and maintain information as generated by all other departments, so that a successful and factual quarterly, semiannual and annual report can be made regarding this plan.
Unfortunately in 1999 RX claims have risen to 30.2% of the total claims paid. This is not a local problem. Globally drug costs throughout the United States have risen substantially over the last 12 months. The national average ratio is 10% - 15% of total claims paid. The Kingston membership usage is 15.2% higher (30.2%). Obviously this has been a concern to Health Net throughout the year. Health Net and Pro Vantage are jointly working to resolve some of the issues without a major overhaul of the co-payment structure at this time. A presentation of our findings will be brought to the attention of the Trust within the first quarter of the year 2000.
Our PPO department has worked diligently in the year 1999, and I am happy to report that our Network has substantially grown, and is still growing as of this writing. We can now boast that Health Net has in excess of 3,100 doctors under contract, 15 hospitals and 270 speciality centers. Our website is being overhauled for easier access by the members, and we will be encouraging its use in the year 2000. Health Link Solutions Incorporated a subsidiary of Health Net Incorporated was formed to reprice at a lower rate out of network claims for the benefit of the Trust and its members. Our success in negotiations in the first 2 months has produced a savings of $31,590.00. It is our goal in the year 2000 to slowly move away from outside repricing companies as well as outside PPO Networks, so that we will have more control over our own destiny.
I am happy to close this report by announcing that the Kingston Trust Fund is in sound financial condition, and for the year 1999 can report to its members a gain based on actual claims, based on actual funding of $343,553.24.
Respectfully,
Joseph E. Fiegoli
President