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Participating Provider (PPO) Network

xrayOur Participating Provider Network is a good illustration of the commitment Island Group has to their clients and the service we provide. In 1985, we first pursued the development of our PPO; primarily to serve the needs and requirements of our public sector clients who desired an alternative to the then conventional methods of providing benefits i.e. (The Empire Plan, a fully insured programs or restrictive HMO programs). We chose to develop our own PPO, rather than merely "buying into" a pre-packaged, "off- the-shelf" PPO. The reason is simple. We deal directly with the practitioners; we credential the practitioners; and we negotiate the reimbursement schedules that the practitioners receive.

The "rent a PPO" method would have excluded a direct relationship with practitioners and Hospitals, and we would have eliminated any ability to negotiate the best rates for our clients. We believed that the "off the shelf" PPO concept would have negatively influenced the results of the self-funded plans we were administering. In 2008, the utilization of our PPO network by our Long Island based clients routinely exceeded 90 per cent and, frequently, reaches 100 per cent utilization by plan participants in a given month. This translates to very significant claims savings for our clients and enhanced benefits for plan participants. What was once considered an impossibility (savings + enhanced benefits), we have been able to make into a reality. It has taken us 20 years to create this particular PPO network, which is growing on a daily basis.

The Island Group Administration Inc. PPO network coupled with the IGA hospital discount program, routinely produces savings of 50% or more in expenditures that would be typified by a self-funded program without discounts or PPO. Some of our established clients on Long Island have seen virtually no increase in their claims expenditures for more than 24 months.

groupWe do not force a provider list on plan participants. We encourage the plan participants to list their own doctors/specialists for us to contact and enroll. Rather than canvassing an area for any provider who would be on any list, we pursue the most reputable providers in each specialty, particularly those located in areas of high utilization that our clients' employees actually use. The plan participants enjoy increased benefits, ie. elimination of deductibles and coinsurance, assignment of benefits though direct billing, ease of claim filing, etc. Our client employers save claim dollars each and every time a plan participant uses a PPO provider. Unlike an HMO program, the plan participants have the free choice of any practitioner, and/or a member of the PPO. This provides the utmost flexibility within the self funded program.

Island Group Administration Inc. has one of the largest preferred provider networks in New York and Long Island and the largest in Suffolk county to date. Virtually all Long Island hospitals participate in the IGA network. The IGA practitioner network is provided at no cost to our clients and is proprietary. Our clients exercise complete control over every aspect of plan utilization and management through IGA by virtue of this fact. Our contracted rates and fees with providers and doctors are noteworthy as it is pivotal to the success of any future program a perspective client may consider, and one of Island Group Administration Inc. greatest strengths. As you are aware, 92% of the costs associated with any program are claims. Historically the collective impact of Island Group contracts/discounts have provided for a 50% savings or more to our clients.

Island Group Administration Inc. is committed to the continuing expansion of our PPO network, so that the maximum results can ultimately be achieved by our clients.

Addendums are provided monthly so that employees and clients are aware of new providers. This information is provided either by hard copy or computer disk.

 
 
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