Coalition America, Inc.

Coalition America, Inc. (CAI) the leader in out-of-area and out-of-network medical claim savings has developed a new solution through its interface with United Healthcare (UHC), Aetna, Regence Blue Cross, and Value Options to provide dramatic savings for one of its largest accounts.

UHC, Aetna, Regence Blue Cross and Value Options all provide claims administration and PPO access services for a not-for-profit association that oversees the national benefit plans for nearly 200,000 personnel who are represented by labor. Likewise, CAI has been providing out-of-area/out-of-network claim discounting services for this association on behalf of its members over the past two years. Currently, if UHC, Aetna, Regence Blue Cross or Value Options receives a medical bill from a provider not in their contracted networks, the claims are sent to CAI for repricing through its multiple supplemental networks or direct negotiations. As a result, CAI saved the association over fourteen and one-half million ($14,500,000) dollars in 2002 on out-of-network and out-of-area claims.

In its efforts to continue to increase savings for the association, CAI performed a detailed claims analysis to determine the impact of utilizing a prominent national network as a "wrap" to obtain discounts. The result was so significant that beginning in April 2003, logos for the network were placed on association member ID cards to increase savings through deeper discounts and increased provider participation. Moving forward, all out-of-area/out-of-network claims will continue to come to CAI for discounting. If the provider is not participating in the network options accessed by the association through the administrators, and is a participating provider of the wrap network, then the claim will be discounted according to the network fee schedule. If the claim is from a non-logo network provider, then CAI will utilize its supplemental PPOs or direct negotiations to achieve savings. CAI’s supplemental PPO networks allow it to access discounts by contract on behalf of its clients.

Since CAI manages all the repricing functions through its EDI and internet applications the result will be significantly greater savings for the association’s members without adding time or resources to the discounting process.

"We are excited about the impact of utilizing a "wrap" network in addition to our multiple supplemental PPOs and negotiations services to enhance our value and savings to the association", said Sean Smith, CEO, Coalition America. "Additionally, we see this as an opportunity to strengthen our relationships with our network partners and a pilot program for other CAI clients" said Smith.

About Coalition America

Coalition America, Inc. (CAI) is the leader in medical claim savings utilizing proprietary technology to leverage discounts on medical bills for payors, insurers, employers and healthcare plans and payors. Clients can interface with CAI either through electronic data interface (EDI) or the Internet to repricing in-network and out-of-area/network medical claims. CAI delivers significant savings through the integration of primary PPO networks, wrap PPO networks, supplemental PPO networks, and direct provider negotiations. The Atlanta-based healthcare savings company services over three hundred clients located throughout the country, offering a one-stop solution for discounting medical bills while reducing administrative costs through technology. For more information on Coalition America, please visit www.coalitionamerica.com or contact Libby Roper, Director of Marketing at 404/459.7201, ext. 5265 or libbyroper@coalitionamerica.com.

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