Aetna Entering Troubled HMO Market in Arkansas.Aetna Inc., the world's largest health insurer, is scrambling to establish a foothold in Arkansas' beleaguered be·lea·guer tr.v. be·lea·guered, be·lea·guer·ing, be·lea·guers 1. To harass; beset: We are beleaguered by problems. 2. To surround with troops; besiege. HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, market -- with hopes that its unique slate of choices will turn a profit where others have lost money and left the state. Aetna U.S. Healthcare Inc. will offer its health maintenance organization to Arkansas individuals and groups beginning Oct. 1 as part of a program to expand and replace the HMO network HMO network Managed care An HMO that contracts with local hospitals to provide in-patient medical services, and with 2 or more independent groups of physicians to provide health services; the group is paid a set amount per HMO enrollee per month; in some, staff now run through Prudential HealthCare. Aetna now runs a preferred provider organization pre·ferred provider organization n. Abbr. PPO A medical insurance plan in which members receive more coverage if they choose health care providers approved by or affiliated with the plan. (PPO PPO abbr. preferred provider organization PPO Managed care Preferred provider organization, see there Infectious disease Pleuropneumonia-like organism, see there ) network in Arkansas with 60,000 members. Aetna bought Prudential HealthCare in August 1999 and has continued to run its health plans for another 34,347 Arkansas members as PruCare. Prudential reported national losses of $211.6 million from its HMO last year. That's up from $63.6 million in national losses for the HMO ranked fourth in Arkansas managed care business. The company was not required to report state-specific results. The state's fourth largest HMO, Cigna-owned Health Source of Arkansas Inc., will have fully withdrawn from the Arkansas market by year's end. United Health Care Inc., Arkansas' second-largest HMO, is slated for hearings before state Insurance Commissioner Mike Pickens in early October to explain allegations of late payments and mishandled claims. HealthAdvantage, the HMO offered by Arkansas Blue Cross Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. , dominates the state's health-care market and has operated in the black. Mike Castleberry, Aetna's Little Rock area sales director, said Aetna has seen a a major improvement in Prudential's loss ratios since it bought the company and is banking on a new HMO product -- a triple-tier plan sold as U.S. Access. Rather than choosing among an HMO, a PPO or a traditional 80/20 indemnity plan indemnity plan, n 1. a plan that provides payment to the insured for the cost of dental care but makes no arrangement for providing care itself. 2. once a year, members can make that choice every time they seek medical help. Users can see their primary HMO physician for a $5 co-payment, see a PPO network specialist for a $20 co-pay, or see any provider by paying the traditional 20 percent of the cost with a $300 deductible. "Aetna has half a dozen plan designs and within those an infinite amount of options," Castleberry said. He said the transition toward profit began six months ago. "From the influx of the businesses that we have been seeing in the last six months, I know our medical loss ratio is very good," he said. "We're at 140 percent of production (membership goals) already this year." Aetna's network includes 28 hospitals and 3,000 physicians statewide. Six of the hospitals and 700 doctors are in the Little Rook rook, term used for a common Eurasian bird (genus Corvus) of the family Corvidae (Crow family), smaller than the American crow. The jackdaw is a European species of the genus. Rooks nest in large colonies, whence the term rookery. area. |
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