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burn center in the region); (2) Neuropsychiatric Institute (to
provide psychiatric beds when LDS Hospital temporarily exceeded
its inpatient capacity); and (3) Pain Management Center. Some
UMC admissions were related to a unique relationship between
Primary Children’s Hospital, a Health Services hospital dedicated
to acute care pediatric services, and UMC’s specialized genetic
research and other pediatric-related teaching and research
programs. In addition, petitioner, Group, and Care entered into
provider agreements with Davis Hospital and Medical Center,
located in Davis County, Utah, because there were no Health
Services hospitals in the immediate area.
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 inpatient hospital
services by: (1) Health Services hospitals (HS); (2) independent
hospitals on petitioner’s panel (Panel-Not Owned); (3)
independent Utah hospitals not on petitioner’s panel (Non Panel-
Utah); and (4) independent hospitals outside of Utah and not on
petitioner’s panel (Non Panel-Non Utah).
Year HS Panel-Not Owned Non Panel-Utah Non Panel-Non Utah
1997 93.5% 1.1% 3.9% 1.6%
1998 91.8% 1.7% 4.7% 1.8%
1999 91.7% 1.8% 4.2% 2.3%
Approximately 60 percent of the inpatient charges for enrollees
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