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PROVIDENT MANAGED CARE AND COST CONTAINMENT PROGRAMS SAVE CUSTOMERS $1.66 BILLION IN 1992; NEARLY 33 CENTS FOR EVERY CLAIM DOLLAR

 CHATTANOOGA, Tenn., April 29 /PRNewswire/ -- Group health customers of Provident Life & Accident Insurance Company (NYSE: PVB), the nation's 14th-largest group insurer(a), saved $1.66 billion in medical claims last year as a result of the company's managed care and other cost containment programs.
 Put another way, Provident saved customers 33 cents for every claim dollar submitted.
 Total charges submitted were $5.04 billion in calendar year 1992, according to Provident's "Summary of Medical Claim Cost Management Savings." The report indicates that savings as a percent of charges increased to 32.9 percent, up from 32.5 percent in 1991.
 "Our number one goal is to help our clients control health care costs without sacrificing quality care," said Dianne Luby, vice president of Managed Care at Provident.
 "In every case, our adjusters and managed care professionals focus on achieving the best outcome for the patient," she added. "In addition, review criteria are constantly updated to reflect the most current medical practice."
 Savings are realized as a result of adjuster intervention, utilization review, system intervention, coordination of benefits, network discounts, case management, hospital audits, usual and customary limits, subrogation, and prompt pay discounts.
 Highlights of the report include:
 -- $746.1 Million Saved Through Adjuster Intervention --
 Adjuster intervention savings are created when Provident's claim
 adjusters scrutinize every claim submitted to catch inaccurate
 charges or inappropriate treatments.
 For example, nearly $480 million in savings occurred because
 charges submitted were duplicates and had been previously
 processed. Other reasons for adjuster intervention include
 claims submitted for non-covered conditions, expenses not covered
 by the insured's plan, and cosmetic procedures that are medically
 unnecessary.
 -- $565 Million Saved Through Coordination of Benefits --
 Claims adjusters and PROCLAIM(R) routinely check patient profiles
 for duplicate dental insurance coverage. This process assures
 that benefit payments to the insured do not exceed the total
 charges for his or her allowable dental expense.
 -- $151.1 Million Saved Through System Intervention --
 Provident's PROCLAIM(R) claim management system screens claims to
 find specific information about coverage, plan design, and
 medical/dental service pricing. System intervention saved
 $40.3 million by detecting claims for services received after the
 insured's coverage had terminated. Other top reasons for system
 intervention include claims for dependents not covered under the
 plan and claims for services received prior to the effective date
 of coverage.
 -- $67.9 Million Saved Through Utilization Review --
 Through utilization review, Provident monitors hospital
 admissions to determine whether hospitalization and length of
 stay are appropriate. Utilization review savings increased 17
 percent in 1992.
 -- $53 Million Saved Through Network Discounts --
 Provider network arrangements are established to help employers
 offer competitive benefits to employees at maximums that are
 usually lower than other reasonable and customary rates in the
 region. Last year, network discount savings rose by nearly $11
 million, or about 20 percent.
 Provident network arrangements also promote quality health care
 through extensive credentialing and monitoring of providers.
 -- $41.2 Million Saved Through Usual and Customary Limits --
 Provident continually reviews claims and denies charges that
 exceed the usual and customary limit. Limits are set using
 procedure data provided by the Health Insurance Association of
 America.
 -- $20.6 Million Saved Through Case Management --
 Potentially catastrophic claims are screened for alternate
 treatment settings and procedures that won't compromise the
 quality of care.
 Additional dollars were saved through subrogation, hospital bill audits, fraud investigation, and prompt pay discounts.
 (a) National Underwriter, 1991 ranking
 -0- 4/29/93
 /CONTACT: Donna Sellers of the Rountree Group, 404-252-7577, for Provident/
 (PVB)


CO: Provident Life & Accident Insurance Company ST: Tennessee IN: INS SU:

RA-BN -- AT013 -- 2860 04/29/93 16:38 EDT
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Date:Apr 29, 1993
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