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panel of some 2,800 physicians including: (1) the primary care
and specialist physicians employed by Health Services; and (2)
2,400 independent physicians.
The following schedule, reflecting petitioner’s experience
for the years 1997, 1998, and 1999, presents the total amounts
(by percentage) that petitioner was billed for physician services
provided by: (1) Physicians employed by Health Services’
physician division (Employed); (2) independent physicians on
petitioner’s panel (Not Employed-Panel); and (3) all other
physicians (Not Employed-Non Panel).
Year Employed Not Employed-Panel Not Employed-Non Panel
1997 21.6% 66.1% 12.3%
1998 21.0% 67.0% 12.0%
1999 20.3% 69.4% 10.3%
C. Hospital Services
Petitioner did not directly own or operate any health care
facilities. Petitioner fulfilled its obligation to arrange for
its enrollees to receive hospital services by contracting with a
panel of hospitals including Health Services hospitals and a
limited number of independent hospitals. A substantial portion
of petitioner’s enrollees’ admissions to independent hospitals
were for admissions to either University of Utah Medical Center
(UMC) or Davis Hospital and Medical Center. In particular,
petitioner arranged for its enrollees to obtain medical services
from UMC’s: (1) Intermountain Burn Center (the only certified
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