IHC Health Plans, Inc. - Page 19




                                       - 19 -                                         
          admitted to Non Panel-Utah hospitals during 1997, 1998, and 1999            
          was attributable to emergency medical care.                                 
               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 outpatient                   
          hospital visits 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  92.1%       3.6%             3.1%              1.3%                   
          1998  90.4%       4.8%             3.7%              1.2%                   
          1999  89.7%       4.8%             4.2%              1.3%                   
               Petitioner generally compensated its contractor hospitals              
          pursuant to a modified diagnosis related group (DRG) payment                
          system under which an enrollee admitted to a hospital on either             
          an inpatient or outpatient basis would be assigned a DRG and the            
          hospital would be paid a fixed fee consistent with the DRG                  
          schedule.                                                                   
               D. Point-of-Service Options                                            
               Petitioner offered several plans (described below) that                
          included a “Plus” or a point-of-service option.  Enrollees in               
          such plans were permitted to use the services of physicians                 
          and/or hospitals outside of petitioner’s network with the                   






Page:  Previous  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  Next

Last modified: May 25, 2011