Ohio Medicine

September / October 2008 Ohio State Medical Association

Special
OSMAPAC
Election Guide Page 13
Justice Stratton

Ohio Supreme Court

Candidates Stratton
and O'Connor
List of Recommended
Justice O'Connor Candidates

www.osma.org • (800)766-6762 • email: info@osma.org

Taking a
Closer Look at
Ohio's Major Insurers
Page 3
 Ohio Medicine
September/October 2008
letter from the president
i n s i d e t h i s i s s u e…

3 Taking a Closer Look: Medical Mutual

of Ohio

3 Medical Mutual of Ohio:

Company Overview

4 MMO’s Customer Service Record

6 MMO's Medical Policies and Review

Process
7 MMO’s Most Common Denial Reasons:
What You Can Do
10 To Contact Medical Mutual of Ohio
12 PC Connection Offers Healthcare-
Specific IT Products to OSMA Members
12 Enrollment Now Open for OSMA it gathered information about the impact of medical decision-making by insurers.
Workers’ Compensation Group Rating
Program
OSMA President Warren F. Muth, MD, FACS
As physicians, we have sometimes had an uneasy relationship with the
news media.  Our issues are complicated, whether the subject is clinical or
reimbursement-related, and we often are anxious about giving up control over how
the issue is reported
However, due in large part to the very complexity of our issues, we need to make
more of an effort to reach the public through the news media.  That is what the
OSMA did about eight months ago when it decided to assist the Toledo Blade as
 
The OSMA, using a survey developed by the Blade, surveyed you, our members,
about this issue.

The Blade’s eight-month investigation and resulting series, “Not what the doctor
13 OSMAPAC Election Guide 2008 ordered: How health insurance plans shape patient treatment,” did a very effective
job of highlighting the problems that Ohio physicians and their patients face daily. 

Did we like everything they had to say about physicians?  No, but we are
addressing those comments. Overall the series did a great job of illustrating for
the public something that physicians have known for decades:  That heavy-handed
cost control measures by insurers are having a very negative impact on patient
care.

Ohio Medicine Disclaimer
This publication provides general coverage of its subject area. It
is provided to OSMA members with the understanding that the
publisher is not engaged in rendering legal, accounting, or other
professional advice or services. If legal advice or other expert
assistance is required, the services of a competent professional
should be sought. The publisher shall not be responsible for any
damages resulting from any error, inaccuracy, or omission contained
in this publication. Paid advertisement may or may not imply OSMA
endorsement.
It is good for the public to hear that message from someone other than their
physician.  And it is good for us to remember that in addition to the general public,
legislators, policy makers and others who help make decisions about health
insurance-related issues, also are reached by this message.
I want to thank all the physicians who took the time to complete this survey, as
well as all of those who participated in the Anthem survey. Your data is invaluable
as we address the draconian methods of the insurers that compromise our ability
to deliver quality care, and to keep our doors open.
Reminder: Register to vote by Oct. 6.

Ohio Medicine Copyright Notice © 2008 by the Ohio State Medical

Association. No part of this publication may be reproduced or
transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage Warren F. Muth, MD, FACS
and retrieval system, without express written permission from the President, Ohio State Medical Association
publisher.
 Ohio Medicine
Taking a
Closer Look:
This issue of Ohio Medicine features the second in
a series of profiles on the major health insurance
carriers in Ohio.
It is the OSMA’s intent that these profiles help educate
members regarding how the major insurance carriers
handle their relationships with physicians and that
they provide points of contact for physician offices as
well as other useful information.
Medical Mutual of Ohio: Company Overview
Medical Mutual of Ohio (MMO) is proud of the fact it is
Ohio home-grown. Founded in 1934, MMO is headquartered in
Cleveland and is the largest health insurance company based in
Ohio. The company also has a primary office in Toledo and local
provider contracting representatives and marketing personnel in
Cincinnati, Columbus and Dayton. All of the company’s customer
service representatives are located in Ohio.
Most of MMO’s 2,900 staff members are located in Cleveland
(1,400 plus) and Toledo (500 plus). The remaining employees
are assigned to the various offices in Ohio, South Carolina and
Georgia. The bulk of MMO’s $2 billion in revenue is generated in
the state of Ohio, which is where the majority of its 4.2 million
customers reside.
MMO handles traditional lines of insurance, as well as managed
care (SuperMed) and Medicare managed care (Advantage plans).
Medical Mutual’s SuperMed Plus was the first PPO in the nation
to be accredited by the National Committee for Quality Assurance
(NCQA). The company’s presence is the most significant in the
northern end of Ohio since it was created with the merger in 1986
of Blue Cross and Blue Shield of Northern Ohio (Cleveland-based)
and Blue Cross and Blue Shield of Northwestern Ohio (Toledo-
based).
However, MMO is moving to establish strong ties in central
Ohio. Although traditionally MMO has catered to the small
September/October 2008
Future editions of Ohio Medicine will contain the
same type of profiles on other key insurers in Ohio. 
It is important to note that the Ohio State Medical
Association is not advocating on behalf of these
insurers, but is simply seeking to provide information
to its members. The OSMA takes its role as physician
advocate very seriously and continues to work at
all levels to assist members who are experiencing
problems with payers.
group market, for several years now it has been in the process
of positioning itself as a player for the lucrative government
contracts in Ohio.
In addition, in the past three years, Medical Mutual has expanded
its scope beyond Ohio, concentrating on the Southeast and
the Midwest regions of the country. MMO’s acquisitions in the
Southeast include a PPO in Georgia and an HMO and PPO in South
Carolina. Its long-range plans include national expansion through
its insurance subsidiary Consumers Life.
Medical Mutual’s Chairman, President & CEO is Kent W. Clapp,
who has been with Medical Mutual and its predecessors since
1976. The Chief Medical Officer is Robert E. Rzewnicki, M.D., a
board-certified rheumatologist who has been affiliated with MMO
since 1987. Dr. Rzewnicki has served as the medical director since
1993 and is responsible for overseeing the nearly 100 actively-
practicing physicians who serve as Medical Mutual’s physician
advisors.
For a list of regional contacts, see the related article on page
10. For a much more complete list of toll-free phone numbers,
categorized by region and subject matter, check on the Medical
Mutual website: www.medmutual.com . On the upper bar, click
on “Providers,” then click on “Tools & Resources,” then “Contact
Us.”

 a closer look
MMO’s Customer Service Record
Health plan customer service is typically a nightmare for
physician offices, but MMO is seeking to make a name
for itself in this area.
As a result, MMO promises to pick up the calls coming
into the Provider Inquiry Unit within seconds and also
promises that its staff will understand the issues being
raised by the practices and be able to respond to them
in a professional manner.  Unlike a number of other
insurers, MMO does not outsource its customer service
to another country.
Robert D. Francis
Chief Operating Officer, The Doctors Company
 Ohio Medicine
paid advertisement
A2241_OhioMedicine.indd 1
Its goal, MMO says, is to address any concerns on
initial calls to the Provider Inquiry Unit. MMO’s customer
service representatives do not transfer calls or refer
physicians or their staff to other phone numbers.
This approach must be making some difference in
physician opinion. Of all the calls coming into the
OSMA regarding plan customer service, MMO receives
by far the fewest complaints.
MMO contact information is listed elsewhere in this
issue.
We fight frivolous claims. We smash
shady litigants. We over-prepare,
and our lawyers do, too. We defend
your good name. We face every
claim like it’s the heavyweight
championship. We don’t give up.
We are not just your insurer. We
are your legal defense army.
We are The Doctors Company.
The Doctors Company built its reputation on the aggressive defense
of our member physicians’ good names and livelihoods. And we do
it well: Over 80 percent of all malpractice cases against our members
are won without a settlement or trial, and we win 87 percent of the cases
that do go to court. So what do you get for your money? More than a
fighting chance, for starters. To learn more about our medical professional
liability program, call our Central Regional Office at (800) 666-6442 or
visit us at www.thedoctors.com.
8/18/08 1:01:52 PM
 Best Practices, Best Value
New! Reduced Rates for Many Ohio Physicians

Unique Approach Leads to Better Rates

American Physicians is committed to insuring the

best doctors and giving them the best coverage
available. Combined with our innovative underwrit-
ing process and unparalleled risk management
support, this business philosophy has allowed us to
reduce rates for many Ohio physicians effective
August 1, 2007.

• Lowest Overall Rates in more than 70 Ohio

Counties (compared to our major competitors)

• 33% Higher Annual Aggregate Limits at No

Additional Cost

• Claims-Free Discount up to 15%

• Free On-Site Risk Management Assessment . . .

$1,500 Value

Rock-Solid Dependability
American Physicians is a highly rated, admitted
carrier with the financial stability and superior
standards the best doctors seek. Year after year,
we’ve kept our promise to provide Ohio physicians
with reliable long-term value. Now, we also offer
lower rates.

Learn more and get a free premium quotation by

calling your agent or 800-748-0465.

www.apassurance.com

Highly Rated by A.M. Best • Endorsed by Medical Societies

September/October 2008 
paid advertisement
 a closer look
MMO's Medical Policies and Review Process
It is important that practices make themselves aware of relevant Special Circumstances
medical policies to ensure timely reimbursement. While no one
practice will be able to keep track of all the medical policies of all the When a case has been denied as investigational and the member
plans they participate in, most insurers, including Medical Mutual of has been diagnosed with a terminal condition, the next step is asking
Ohio (MMO), offer web access to their policies. MMO for an independent three physician panel review.

Medical Mutual’s extensive Corporate Medical Policies (CMP) address
medical necessity, technology assessment and a long list of other
issues. There are nearly 200 procedures, therapies, technologies
or devices currently covered in MMO’s Corporate Medical Policies.
These include such diverse topics as bariatric surgery, facial muscle
surgery, carotid artery stenting, and intrauterine fetal surgery. MMO’s
policy descriptions also include specific clinical criteria that must be
met for services to be considered medically necessary. MMO utilizes
a variety of physicians with specialized qualifications to consult on
the development of a medical policy in emerging specialty areas.
The Corporate Medical Policies are accessible online in the Provider
section of medmutual.com under the Tools and Resources subsection.
Medical Policies are organized by subject matter and are cross-
referenced by specific CPT codes. The list includes both the initial
policy development date and the most recent review date. Each
individual policy includes the pertinent CPT codes, a review of the
procedure/protocol/technology and the clinical criteria for medical
necessity.
Investigational Services
The Company develops CMPs for many emerging pharmaceuticals,
medical devices, medical/surgical/behavioral health services and
procedures. This process determines whether the subject of review
medically necessary or investigational.
MMO indicates that the important elements that are considered by
its physician consultants when recommending 'medically necessary'
or 'investigational' status include, but are not limited to:
• Is there approval by the appropriate governing body?
• How extensive and how sound are the supporting clinical
scientific data?
• Do these data demonstrate inferiority, equivalence or
superiority to currently accepted, standard approaches?
• Has the subject of review become widely used by community
practitioners?
According to MMO each reviewer will consider the following
information in conducting the review:
• All information submitted by Medical Mutual, the insured’s
physicians and healthcare providers, including but not
limited to the insured’s medical records and the policies,
guidelines, criteria and clinical rationale used by Medical
Mutual to reach its initial coverage decision.
• Relevant current peer-reviewed scientific literature,
published medical expert opinions and clinical guidelines
established by specialty societies.
• Findings, studies, research and other relevant documents of
government agencies.
• Safety, efficacy, appropriateness and cost effectiveness.
Medical Necessity Review Process
Medical Mutual refers to the process of determining medical
necessity as “Prior Approval.” MMO indicates that its decisions are
based upon the facts of each situation presented using Corporate
Medical Policies and Interqual criteria as guidelines.
When a request for prior approval is received, it is initially reviewed
by a licensed nurse. The nurse reviewer has the ability to approve the
service, but does not have the authority to issue a denial of service.
If the MMO nurse determines that its medical necessity guidelines
are not met, he or she forwards the case to one of Medical Mutual’s
physician advisors.
These physician advisers are not employees of Medical Mutual. They
are practicing physicians representing a variety of specialties. Most
reviews are conducted by a single physician reviewer. The requesting
physician and the covered person are notified by MMO of the review
determination. If the service is not approved, a letter will be sent
explaining the denial reason(s), the specific criteria used, and how
to reach a physician adviser to discuss the reconsideration of the
initial denial decision, as well as information on appeal rights and
process.

• Is there a recommendation by a nationally recognized The attending physician may contact MMO within 10 days to ask for
authoritative body or expert panel? reconsideration, which is then carried out via peer-to-peer interaction
with a physician advisor. All reconsideration requests are handled
There is a separate section on MMO's website that contains CMPs through MMO’s Care Management Department at (800)338-2873.
resulting in an 'investigational' determination. MMO recommends that when calling for reconsideration, physicians
should use the “priority” option listed in the phone menu. If the
physician is not satisfied with the outcome of the reconsideration, an
appeal may be filed as described in the initial denial letter.
 Ohio Medicine
 MMO’s Most Common Denial Reasons: What You Can Do
Listed below are Medical Mutual of Ohio’s top five reasons for
reimbursement denials, according to information provided to the
OSMA by MMO. They are listed in descending order, beginning
with the most frequent reason for denial. The OSMA is seeking
this type of information from all major Ohio insurers in order to
help practices become more cognizant of denial reasons. Below
each denial is practical information regarding the steps you can
take to avoid these denials.
Claim is a duplicate – Many practices when they are not certain
if MMO has received their claim, resubmit it. Once the original
claim gets adjudicated then any duplicates will be denied. While
some practices use resubmission as a strategy to make sure all
claims are received by MMO, there is a better and cheaper way
to achieve this.
What to do: Remember that when you submit a claim it goes
from your practice management system to your clearinghouse,
and then from your clearinghouse to Emdeon, which serves
as MMO’s clearinghouse, and then on to MMO. The claim
submission pipeline could break down anywhere along the way.
What is important to you is whether MMO has received it and is
going to pay it. If you file your claims electronically, you should
review the claims received report sent from Emdeon to your
clearinghouse vendor, as this report will advise you if the claim
was received by MMO. If the report indicates that the claim was
received by MMO, use Emdeon Office or contact MMO’s Provider
Inquiry Unit at (800) 362-1279 to check claim status.
requested information. The information could be requested from
either the patient or the medical practice.
What to do: If MMO has requested medical history information
from your practice, it is important to return the completed
information as quickly as possible. This clears the way for you to
submit claims on behalf of this patient. The OSMA’s position on
this type of denial is that this is an issue between the patient and
the insurance company and physician claims should not be held
up as a result. The OSMA is currently discussing our position with
payer representatives.
An Explanation of Medical Benefits (EOMB) is needed in
order for secondary benefits to be considered – This denial
happens often when Medicare is the primary payer and MMO
is the secondary payer. The practice simultaneously sends a
claim to Medicare and MMO. MMO will deny the claim because
the primary payer has not processed its portion and the proper
crossover of the claim has not taken place.
continued on page 8

If you suspect that MMO is not receiving your claims despite what
the claims received report indicates, contact your clearinghouse
to verify the reports accuracy. If you require further assistance,
contact Emdeon to resolve the issue. If Emdeon cannot resolve
the issue to your satisfaction, contact the Provider Inquiry Unit
or your local MMO contracting representative. This saves you
any additional claim submission fees (for example, from your
clearinghouse) and saves staff time having to account for denied
duplicate claims.

Finally, if you have reason to believe that any payer’s denials may
constitute a pattern of practice by the company, please contact
the OSMA’s payer relations staff. Remember, you would need to
have solid documentation to support this assertion, as this is a
very serious charge that insurance companies take pains to guard
against.

Claim will not be processed until information regarding the

patient’s treatment history is received – In other words, MMO
has sent a request for additional information regarding a patient’s
medical history and will not process this claim until it receives the
September/October 2008 
paid advertisement
 a closer look
What to do: This is one of the easier fixes. If you file the claim
with Medicare and include all of the proper crossover information
for MMO as the secondary payer, then all you have to do is wait
for Palmetto (Medicare) to process the claim. After Palmetto
processes the claim , it will automatically be sent to MMO for
processing and you should receive your secondary payment. If you
try to file the secondary claim directly with MMO and it does not
have the associated EOMB from Palmetto, then MMO will deny
the claim. If you haven’t received payment on the secondary claim
30 days after you receive the EOMB from the primary payer, then
it’s time to check into the status of the claim.
Patient not eligible – This type of denial is becoming more
frequent among all insurance companies. As more Americans lose
their health insurance, patients may knowingly or unknowingly
present an outdated insurance card to the practice. The problem
is that if you assume that the patient has coverage and you bill
that insurance company, it may take you 30 days or more to find
out from the insurance company that the patient does not have
coverage. A month later, it’s much harder to collect your charges
from the patient.
What to do: In today’s business environment, you must know
how you are going to receive payment for the service before you
provide the service. When the patient hands you an insurance card
at check-in, you need to verify that the patient does indeed have
coverage. If the patient does not have the necessary coverage,
then its time to have a conversation with the patient about how
they are going to pay for the service. For MMO patients,Ad
R747-ENT youfor
canOhio
check eligibility using Emdeon Office, a
service available to all MMO network
physicians. If you wish to use Emdeon
Office for Medical Mutual information
only, a no-cost solution is available to
Medical Mutual’s Network physicians.
Visit the Provider section of MedMutual.
com for more details. To use Emdeon
Office as all-payer solution, you can
register through MMO’s web site or call
(877) 469-3263. Additionally, MMO’s
VoiceConnect (Voice Response Unit) is
available 24 hours a day, 7 days a
week at (800) 362-1279. During regular
business hours, representatives in the
Provider Inquiry Unit are also available
to speak with physicians.
Shauna Brown, Sr. Conference Manager • UPMC/Center for Continuing Education in the Health Sciences
Telephone: (412) 647-9541 • Fax: (412) 647-8222 • E-mail: brownsr@upmc.edu
To register online, please go to our web site at http://ccehs.upmc.edu/formalCourses.jsp#1779
 Ohio Medicine
Additional information is needed on the claim – In these
cases, vital information was omitted on the submitted claim.
The most common pieces of information missing from a claim
receiving a denial of this kind are: 1) date of accident; 2) date of
medical emergency; 3) date of onset.
What to do: The physician is advised to submit a corrected claim
with the missing information. If the physician needs guidance
as to what information is missing, service representatives at
MMO’s Provider Inquiry Unit are available at (800) 362-1279
during normal business hours. Additionally, MMO encourages
physicians to reference the Claims Submission section of the
Professional Provider Manual (PPM). MMO’s PPM, with full
keyword search capability, is available online in the Provider
section of MedMutual.com under Tools and Resources.
The denial reasons listed above occur when a claim cannot be
adjudicated. When payment is denied because the patient does
not have a covered benefit for the service provided, the claim
was adjudicated by MMO but your Notice of Payment will advise
you that MMO is not responsible for the reimbursement of those
services and the money owed will show as patient liability. This
highlights the importance of verifying benefits prior to providing
service. The patient may have a MMO insurance package, but the
service or procedure that you are about to provide might not be
covered by the policy. Check the patient’s coverage using Emdeon
Office or use MMO’s VoiceConnect (Voice Response Unit) at (800)
362-1279.
Med:R747-ENT_Ad_for_OM 8/21/08 10:45 AM Page 1
2 3 R D S Y M P O S I U M :
Ear, Nose & Throat Disorders
in Children: 2008 Update
N o v e m b e r 1 4 - 1 5 , 2 0 0 8
Herberman Conference Center • UPMC Shadyside
5150 Centre Avenue • Pittsburgh, Pennsylvania
Course Directors
Sponsored by:
University of Pittsburgh School of Medicine
Margaretha L. Casselbrant, MD, PhD
Center for Continuing Education
in the Health Sciences David H. Chi, MD
and David L. Mandell, MD
Children’s Hospital of Pittsburgh of UPMC
Department of Otolaryngology All Course Directors are affiliated with the
Division of Pediatric Otolaryngology University of Pittsburgh School of Medicine and
Children’s Hospital of Pittsburgh of UPMC
For more information, contact:
paid advertisement
 5IF
TUSFOHUI

EFGFOTF
BOE
DFOUVSZMPOH
TPMVUJPOT
PG
.FEJDBM
1SPUFDUJWF
5IF
TFDVSJUZ
BOE
SFTPVSDFT

PG
#FSLTIJSF
)BUIBXBZ
we bought
…On June 20, 2005
107 year-old …We want Medical
Medical Protective, a
urer based in
medical malpractice ins Protective to continue
insurance is
Fort Wayne. Malpractice to be the company that
has proved to
tough to underwrite and thinks like a doctor and
insurers. As
be a graveyard for many behaves with the same
al Protective
part of Berkshire, Medic integrity and individual
exceeding
has financial strength far
s, a quality care as a doctor….
that of its competitor
viders that
assuring healthcare pro
ll not end up
long-to-settle claims wi – from Warren Buffett,
because their April 26, 2006
back on their doorstep
insurer failed….
ter to
– from Warren Buffett’s Let
28, 2006
Shareholders, February

…We’re proud to have

Medical Protective as part
of the Berkshire family…. – from Warren Buffett,
May 30, 2006

/PX
JT
UIF
UJNF
GPS
ZPV
UP
DPOTJEFS
KPJOJOH
UIF
UFOT
PG

UIPVTBOET
XIP
FOKPZ
UIF
VONBUDIFE
QSPUFDUJPO
UIBU
POMZ

.FEJDBM
1SPUFDUJWF
DBO
QSPWJEF

#FTU
¹OBODJBM
TUSFOHUI

.PTU
XJOOJOH
EFGFOTF

4NBSUFTU
TPMVUJPOT

$PNNJUUFE
TJODF


"MM
QSPEVDUT
BSF
VOEFSXSJUUFO
CZ
FJUIFS
5IF
.FEJDBM
1SPUFDUJWF
$PNQBOZˆ
PS
/BUJPOBM
'JSF
BOE
.BSJOF
*OTVSBODF
$PNQBOZ ˆ
NFNCFST
PG
UIF
#FSLTIJSF
)BUIBXBZ
HSPVQ
PG
CVTJOFTTFT


1SPEVDU
BWBJMBCJMJUZ
WBSJFT
CBTFE
VQPO
CVTJOFTT
BOE
SFHVMBUPSZ
BQQSPWBM
BOE
NBZ
CF
PGGFSFE
PO
BO
BENJUUFE
PS
OPOBENJUUFE
CBTJT
‰
5IF
.FEJDBM
1SPUFDUJWF
$PNQBOZˆ
"MM
3JHIUT
3FTFSWFE

4FSWJOH
0IJP
IFBMUIDBSF
QSPWJEFST
TJODF
 
$BMM


.&%130

PS
ZPVS
JOEFQFOEFOU
BHFOU
UPEBZ
GPS
ZPVS
'3&&
FYQFSU
HVJEF
UP
0IJP
NFENBM
JOTVSBODF

%FGFOE
ZPVS
SFQVUBUJPO
BOE
BTTFUT






7JTJU
NFEQSPDPN






$BMM
.&%130






$POUBDU
ZPVS
JOEFQFOEFOU
BHFOU
September/October 2008 
paid advertisement
 a closer look
To Contact Medical Mutual of Ohio
Professional Contracting Phone Numbers
South (Cincinnati)
800/589-2583 or 513/684-8140
Counties: Adams, Brown, Butler, Clermont, Hamilton,
Pike, Ross, Scioto
Northeast (Cleveland)
800/625-2583 or 216/687-6064
Counties: Ashtabula, Belmont, Carroll, Columbiana,
Cuyahoga, Geauga, Guernsey, Harrison, Holmes,
Jefferson, Lake, Lorain, Mahoning, Medina, Portage,
Stark, Summit, Trumbull, Tuscarawas, Wayne
South (Columbus)
800/235-4026 or 614/932-7270
Counties: Athens, Coshocton, Delaware,
Fairfield,Gallia, Hocking, Jackson, Knox, Lawrence,
Licking, Marion, Meigs, Monroe, Morgan, Morrow,
Muskingum, Noble, Perry, Vinton, Washington
South (Dayton)
800/422-8339 or 937/898-3350
Counties: Champaign, Clark, Clinton, Darke,
Fayette, Greene, Hardin, Highland, Madison, Miami,
Montgomery, Pickaway, Preble, Shelby, Union, Warren
Northwest (Toledo)
888/258-3482 or 419/473-7455
Counties: Allen, Ashland, Auglaize, Crawford,
Defiance, Erie, Fulton, Hancock, Henry, Huron, Logan,
Lucas, Mercer, Ottawa, Paulding, Putnam, Richland,
Sandusky, Seneca, Van Wert, Williams, Wood,
Wyandot
Community Health Centers
Teamwork Leads to Quality Healthcare...Hands Down
Medical Directors
Leaders Needed
Mission Focus
Provider Inquiry Workers’ Compensation
Benefit, Eligibility, Claim Status Inquiry for all PPO, CareWorks Customer Service: 888/627-7586
POS and HMO products
Voice Connect: 800/362-1279 BWC Certification Update: 800/477-2292
Care Management BWC Provider Access Line: 800/644-6292
Utilization Management Inpatient Prior Approval CareWorks (C-9 Referral)
Cleveland: 800/258-2873 (Fax request for authorizations [C-0 forms])
Utilization Management Inpatient Prior Approval/
Toledo: 800/338-4114 CareWorks FROI (First Report of Injury)
888/627-6586
Behavioral Health Utilization Management/
Case Management Prior Approval Others
800/258-3186 Coordination of Benefits
800/782-5869 or 216/687-7630
Home Health/Skilled Nursing Prior Approval
800/258-2873 or 800/338-4114 Electronic Claims: 800/321-7223
MRI/MRA/PET Prior Approval Subrogation: 800/442-2911
800/258-2873 or 800/338-4114
Emdeon (to register): 877/469-3263
Corporate Medical Policy for Services/
Procedures/DME Requiring Prior Approval Medical Mutual of Ohio has provider contracting
Cleveland Case Management: 800/258-3175 offices throughout the state. The state is divided
into three main geographic regions: Northeast,
Clinical Quality Improvement Department Northwest, and South; with local provider
800/586-4523 contracting representatives living and working in
the same communities as the providers they serve.
Your patients trust
your expertise.
You can trust ours.™
At Banc of America Practice Solutions™, you can rely on our
industry leadership. The expertise of our financial specialists
and the convenience of a simple Express Application can
help you secure equipment and Electronic Medical Record
financing in as little as three hours.*
Call 1.800.491.3634 to learn more.
Please mention Priority Code 4N4H7. Or visit us online at
www.bankofamerica.com/practicesolutions.
Quality Assurance   #NNRTQITCOUUWDLGEVVQETGFKVCRRTQXCNCPFNQCPCOQWPVUCTGUWDLGEVVQETGFKVYQTVJKPGUU
Team Environment 5QOGTGUVTKEVKQPUOC[CRRN[
  $CPEQH#OGTKEC2TCEVKEG5QNWVKQPU+PEKUCUWDUKFKCT[QH$CPMQH#OGTKEC%QTRQTCVKQP$CPMQH#OGTKEC
Contact: Peter LaBianca, Director of Workforce Development KUCTGIKUVGTGFVTCFGOCTMQH$CPMQH#OGTKEC%QTRQTCVKQPŠ$CPMQH#OGTKEC%QTRQTCVKQP

(888) 884-3101 plabianca@ohiochc.org

www.ohiochc.org
4150 Indianola Avenue
Columbus, Ohio 43214
10 Ohio Medicine
paid advertisement paid advertisement
 Go on about your business, Doctor.
We’re watching out for you.
We know that choosing a malpractice insurance
provider is a matter of trust. A matter of comfort.
A matter of finding a company you can count on to
provide the coverage, the service, the peace of mind.

COMMITTED
Professional Solutions Insurance Company offers the
protection you need to concentrate on your practice.
Professional Solutions has earned an “A” (Excellent)
rating from A.M. Best for our financial stability and
ability to pay claims. You’ll appreciate our experience
and expertise as we provide you and your practice
with long-term protection.

For a free, no-obligation coverage review, call

1-800-718-1007 ext. 9172 or
visit www.profsolutions.com today.

INSURANCE
COMPANY

Malpractice insurance underwritten by Professional Solutions Insurance Company.

A.M. Best ratings range from A++ to S. ©2008 PSIC NFL 9172

September/October 2008 11
paid advertisement
 practice ser vices
PC Connection Offers Healthcare-Specific
IT Products to OSMA Members
The Ohio State Medical Association is
pleased to announce its new partnership
with PC Connection, a leading information
technology solutions provider offering
more than 150,000 brand name healthcare
and IT products. Through the partnership,
OSMA members have access to special
pricing on notebook and desktop
computers and related peripherals,
software, and networking products and
accessories.
“OSMA is very excited to offer this type
of program to our members,” said Dave
Owens, OSMA Senior Director of the
Membership Group and Chief Marketing
Officer. “We researched several different
companies and found that PC Connection
truly understands the healthcare IT
needs of physician practices. As an
added benefit, its distribution center is
conveniently located in Wilmington, Ohio,
offering our members guaranteed next-
Ohio Publications
day delivery.”
Members also have access to Health-
Connection, an initiative of PC Connection,
which focuses solely on healthcare-
specific IT products. HealthConnection
helps physician practices address five
key elements necessary to improve
workflow efficiency and quality of care:
infrastructure, mobility, point of care,
document management, and compliance.
PC Connection was founded in 1982
and is a leading information technology
provider to businesses, government
agencies, educational institutions, and
consumers. PC Connection serves its
customers through highly-trained account
managers, websites and specialized IT
product catalogs.
For more information, please visit the
OSMA website at www.osma.org or
contact Maureen Kraft at (800) 766-6762
or mkraft@osma.org.
Enrollment Now Open
for OSMA Workers’
Compensation Group
Rating Program
Enrollment is now open for the 2009 OSMA
Workers’ Compensation Group Rating
Program, the largest physician-only pool
in the state. By participating in OSMA’s
program, members can save up to 77%
on workers’ compensation premiums,
which is the highest discount available.
Last year, OSMA’s program was able to
save participants more than $2 million in
premiums to the BWC.
To receive a no obligation evaluation and
quote, go to www.osma.org and click 2009
OSMA BWC Group Rating Program under
the Hot Topics section. If you have questions
about the program or membership, please
call Cindy Wolfe at the OSMA at (800) 766-
6762 or email at cwolfe@osma.org.

Provide your patients

better care.
From the comfort of
their home.
Visiting Physicians Association is one of America’s leading geriatric house call practices. We bring comprehensive
modern medicine to the comfort of the patient’s home. As leaders in the treatment of the frail aging,
you will have the resources to provide better care to your patients.

You’ll enjoy:
More one-on-one time with your patients • Continuity of care • Average 10 appointments per day
Weekday schedule • No nights or weekends • No hospital rounds • A dedicated medical assistant

You will further be supported with:

Trained support staff committed to providing quality care
State-of-the-art lab and mobile diagnostics • Malpractice insurance and full benefits
Orientation, mentoring, team support • Company provided transportation

Looking to practice quality medicine while raising your quality of life? Contact us today!
Opportunities throughout Ohio:
Cincinnati, Cleveland, Columbus, Dayton and Youngstown
Fax your CV: 1-800-707-3167 or contact Jeanne: 1-877-531-9955
jheyn@visitingphysicians.com

12 www.visitingphysicians.com
Ohio Medicine
paid advertisement
 OSMAPAC
Election Guide 2008
November 4, 2008
Undecided about how you are going to vote in the November elections? Included in this issue is the Ohio State Medical Association
Political Action Committee (OSMAPAC) 2008 Election Guide, which includes its voting recommendations regarding the candidates that
best reflect the concerns of the medical community and issues of concern to physicians and their patients. See below for OSMAPAC’s
recommendations on specific races, as well as important information on how to vote early.

Ohio Supreme Court

The Ohio Supreme Court elections remain a top priority for Ohio physicians. The OSMA and its members worked tirelessly to pass tort
reform and to elect Supreme Court candidates who have a respect for the separation of powers between the judicial and legislative
branches of government. We have seen the fruits of our labor: the medical liability marketplace in Ohio is stabilizing, and the Supreme
Court is now comprised of a majority of Justices who believe in interpreting the law rather than legislating from the bench. Nevertheless,
we cannot become complacent. Ohio physicians have come too far to relinquish the Court to activist judges who don’t believe in judicial
restraint.

Justice Evelyn Lundberg Stratton Justice Maureen O’Connor

Justice Evelyn Lundberg Stratton, an incumbent member of the
Ohio Supreme Court with almost 20 years of experience on the
bench, is seeking to retain her position on the Court. Stratton
was appointed as Justice in 1996 and was elected to a second
term in 2002. This is the second time OSMAPAC has endorsed
her candidacy, because Stratton remains balanced and impartial
in her approach to cases before the Court. She has demonstrated
a commitment to judicial restraint, adhering to the philosophy
that the Court’s job is to interpret law, not re-write it. OSMAPAC
strongly endorses her candidacy.
Justice Maureen O’Connor was endorsed by OSMAPAC in 2002
during her first run for the Ohio Supreme Court. O’Connor has had
a long career in public service, serving as a prosecuting attorney,
judge, and Lieutenant Governor. With more than 20 years of
experience on the bench, she has proven to be a fair and objective
Justice. She shares a strong belief in judicial restraint, believing
that the Court’s role does not expand beyond interpretation of the
law. OSMAPAC strongly endorses Justice O’Connor for re-election
to the Ohio Supreme Court.

Absentee (Early) Voting

In order to make voting more convenient and to help voters avoid long lines on Election Day, Ohio now has what is known as “no excuse”
absentee voting. This means that any qualified Ohio voter can obtain an absentee ballot without stating a reason.
Absentee voting begins 35 days before the general election (September 30, 2008) and ends the day before the election (November 3,
2008). Once absentee ballots are available for voting, any voter may receive and return an absentee ballot in person at the county board
of elections office, or receive and return the absentee ballot by U.S. Mail.
Absentee ballots must be applied for in writing. If you are properly registered to vote, you must submit your written request to the board
of elections of the county in which your voting residence is located. You may, but are not required to, use an application form prescribed
by the Ohio Secretary of State. That form can be found at www.sos.state.oh.us.

September/October 2008 13
Election Guide 2008

U.S. House of Representatives Ohio House of Representatives (continued)

Endorsements 22 John Carney Columbus
District Endorsed Candidate City 23 Cheryl Grossman Grove City
24* Neutral Columbus
1* Neutral Cincinnati
25 Dan Stewart Columbus
2 Victoria Wulsin Cincinnati
26 Tracy Heard Columbus
3 Michael Turner Dayton
27 W. Carlton Weddington Columbus
4 Jim Jordan Urbana
28 Virgil Lovitt Springdale
5 Robert Latta Bowling Green
29 Louis Blessing, Jr. Cincinnati
6 Charlie Wilson St. Clairsville
30 Robert Mecklenborg Cincinnati
7 Steve Austria Springfield
31 Denise Driehaus Cincinnati
8* Neutral West Chester
32 Dale Mallory Cincinnati
9 Marcy Kaptur Toledo
33 Tyrone Yates Cincinnati
10 Jim Trakas Cleveland
34* Neutral Cincinnati
11** Shaker Heights
35* Neutral Madeira
12 Patrick Tiberi Columbus
36 Seth Morgan Huber Heights
13 Betty Sutton Akron
37 Peggy Lehner Kettering
14 Steven LaTourette Painesville
38 Terrance Blair Dayton
15 Steve Stivers Columbus
39 Clayton Luckie Dayton
16* Neutral Canton
40 Roland Winburn Dayton
17 Tim Ryan Youngstown
41 Brian Williams Akron
18 Zack Space Dover
42* Neutral Hudson
43 Stephen Dyer Green
Ohio House of Representatives 44 Vernon Sykes Akron
Endorsements 45 John Otterman Barberton
District Endorsed Candidate City 46 Barbara Sears Sylvania
47 Peter Ujvagi Toledo
1 Linda Bolon Columbiana
48 Edna Brown Toledo
2 Kris Jordan Powell
49 Matt Szollosi Oregon
3 Ron Amstutz Wooster
50 Todd Snitchler Uniontown
4 Matt Huffman Lima
51 Scott Oelslager Canton
5 Gerald Stebelton Lancaster
52 Stephen Slesnick Canton
6 Randy Gardner Bowling Green
53* Neutral Hanover Township
7 Kenny Yuko Euclid
54 Courtney Combs Fairfield
8 Armond Budish Beachwood
55 Bill Coley West Chester
9* Neutral Cleveland Heights
56 Joe Koziura Lorain
10* Neutral Cleveland
57 Matt Lundy Elyria
11 Sandra Williams Cleveland
58 Terry Boose Norwalk
12 Michael DeBose Cleveland
59 Ronald Gerberry Austintown
13* Neutral Lakewood
60* Neutral Youngstown
14 Mike Foley Cleveland
61* Neutral Alliance
15 Timothy DeGeeter Parma
62 Lorraine Fende Willowick
16* Neutral Westlake
63* Neutral Mentor
17 Josh Mandel Lyndhurst
64 Thomas Letson Warren
18 Colleen Grady Strongsville
65 Sandra Stabile Harwood Niles
19 Brad Lewis Groveport
66 Joseph Uecker Loveland
20 Nancy Garland Gahanna
67 Shannon Jones Springboro
21 Kevin Bacon Columbus

14 Ohio Medicine

Ohio House of Representatives (continued)
68 Kathleen Chandler Kent
69 William Batchelder Medina
70 Jarrod Martin Beavercreek
71 Jay Hottinger Newark
72 Ross McGregor Springfield
73 Jay Goyal Lexington
74 Bruce Goodwin Defiance
75 Lynn Wachtmann Napoleon
76 Cliff Hite Findlay
77 James Zehringer Maria Stein
78 John Adams Sidney
79 Richard Adams Troy
80* Neutral Port Clinton
81 Jeff Wagner Sycamore
82* Neutral Marion
83 David Burke Marysville
84* Neutral London
85 John Schlichter Washington Court House
86 David Daniels Greenfield
87 Clyde Evans Rio Grande
88 Danny Bubp West Union
89 Todd Book Portsmouth
90* Neutral Mount Vernon
91 Dan Dodd New Lexington
92* Neutral Athens
93 Jennifer Garrison Marietta
94 Troy Balderson Zanesville
95 John Domenick Smithfield
96 Allan Sayre Dover
97* Neutral Ashland
OSMAPAC: How the Endorsement Process Works
OSMAPAC, the Ohio State Medical Association Political Action
Committee, fights for Ohio physicians by helping to elect state
and federal candidates who support the OSMA’s policy agenda. By
electing legislators who will reduce the cumbersome regulations
that inhibit the practice of medicine, the OSMA is equipped
with the political muscle to enact meaningful reforms for the
healthcare industry.
OSMAPAC was established to promote the improvement
of government for physicians and their patients. OSMAPAC
encourages physicians and patients to understand the important
political issues that affect the practice of medicine.
September/October 2008
Election Guide 2008
Ohio House of Representatives (continued)
98 Matthew Dolan Novelty
99 Deborah Newcomb Conneaut
Ohio Senate
Endorsements
District Endorsed Candidate City
2 Mark Wagoner Toledo
4 Gary Cates West Chester
6 Jon Husted Kettering
8 Bill Seitz Cincinnati
10 Chris Widener Springfield
12 Keith Faber Celina
14 Tom Niehaus New Richmond
16 Jim Hughes Columbus
18 Tim Grendell Chesterland
20 Jimmy Stewart Athens
22 Bob Gibbs Lakeville
24 Tom Patton Strongsville
26 Karen Gillmor Dublin
28 Tom Sawyer Akron
30 Jason Wilson Columbiana
32 Capri Cafaro Hubbard
* In races marked *, OSMAPAC believed that both candidates demonstrated an
understanding and open-minded approach to the healthcare issues facing Ohio and the
physician community. OSMAPAC encourages you to become further educated on the
platforms of these candidates and decide for yourself which person would best address
the future of healthcare in Ohio.
** In races marked with **, all candidates have not been identified; therefore, OSMAPAC
has not yet taken a position. Please check the OSMA website for updated information.
The OSMAPAC Board of Directors made endorsements based on
the following criteria:
• A candidate’s philosophy on key issues;
• A candidate’s voting record (if applicable);
• District demographics and a candidate’s ability to win; and
• Recommendations from local OSMA members.
For information about joining OSMAPAC, contact Sara Kaminski,
Political Affairs Coordinator, Ohio State Medical Association by
calling (614) 527-6747 or by emailing her at: skaminski@osma.
org 
15
3401 Mill Run Drive • Hilliard, OH 43026

Return Service Requested