1987-1792043L
AN ORDINANCE AUTHORIZING THE MAYOR TO EXECUTE AGREEMENTS WITH
SOUTHWEST PREFERRED HEALTH NETWORK FOR A PREFERRED PROVIDER PLAN
AND FOR HEALTH SERVICES FOR ITS EMPLOYEES, AUTHORIZING THE
EXPENDITURE OF FUNDS THEREFOR, AND PROVIDING AN EFFECTIVE DATE
WHEREAS, the City has advertised and accepted proposals for a
preferred provider plan and for health services for City
employees, and
WHEREAS, the City Manager having recommended to the City
Council that the proposals of Southwest Preferred Health Network
for said insurance coverages be accepted as being the best
proposal received by the City, NOW, THEREFORE,
THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS
SECTION I That the City hereby accepts the proposal of
Southwest Preferred Health Network for the City's employee health
plan for its employees and for a preferred provider plan, copies
of which proposals are attached hereto and incorporated by
reference herein
SECTION II That the Mayor is hereby authorized to execute
said plah agreements
SECTION III That the expenditure of funds for such
insurance coverages and programs are hereby authorized
SECTION IV That this ordinance shall become effective
immediately upon its passage and approval
PASSED AND APPROVED this the~_~__~l'~day of October, 1987
RAY ST~H~NS, NfAYOR
ATTEST
J~NI~ER[WALTERS; CITY SECRETARY
A~PROVBD AS TO LEGAL FORM
DEBRA ADAMI DRAYOVITCH, CITY ATTORNEY
PREFERRED PROVIDE ORGANIZATION AGREEMENT
BETWEEN
CITY OF DENTON
AND
SOUTHWEST PREFERRED HEALTH NETWORK~ INC
This Agreement 1s entered into this ist day of November, 1987, by and
between the City of Denton and Southwest Preferred Health Network, Inc (SPHN),
a co-po-at,o- organized under the laws of the s~ nf T~
WHEREAS, City of Denton wishes to create a preferred provider panel
which will agree to comply with the reimbursement mechanisms established by City
of Denton and which w~ll participate in and comply with the pollcles and
procedures which may be adopted from time to t~me by ~t, and
WHEREAS, Clty of Denton wlll offer to certain employees the
opportunity to participate in a Preferred Provider Plan (PPO Plan) which
utlllzes the services of the SPHN preferred provider panel, and
WHEREAS, the parties desire, to the extent feasible to utilize such
cost containment methods and practices as are consistent w~th sound medical
practice and in accordance with accepted community professional standards for
rendering quality care,
NOW, THEREFORE, in consideration of the promises and mutual covenants herein
contained and other good and valuable consideration, the sufficiency of which is
hereby acknowledged, the part~es agree as follows
ARTICLE I DEFINITIONS
1 0 The "Plan" shall mean the C~ty of Denton Health Benefit Plan and any
amendments thereto
1 i "Covered Medical/Hospital Services" means all outpatient and inpatient
serwces prowded by Participating Providers to a Participating Patient for
which City of Denton is obligated to pay or reimburse pursuant to the Plan
i 2 "Medically Necessary" means services or supplies which, under the
provisions of this Agreement, are determined to be
a Appropriate and necessary for the symptoms, d~agnos~s or treatment
of the medical condition, and
b Provided for the diagnosis or direct care and treatment of the
medical condition, and
c Within standards of good medical practice w~thln the organized
medical community, and
d Not primarily for the convenience of the Participating Patient,
the Participating Patient's physician or another provider, or for use by the
Participating Patient's Legal Counsel whether or not for or in anticipation of
l~t~gat~on, and
e The most appropriate supply or level of serwce which can safely
be provided For hospital stays, this means that acute care as an inpatient is
necessary due to the kind of serwces the Participating Patient is receiving or
the severity of the Participating Patient's condition, and that safe and
adequate care cannot be received as an outpatient or in a less intensified
medical setting
i 3 "Participating Patient" means an employee of City of Denton and his
dependents who are covered under the Plan and who have elected to receive care
from Participating Providers and to assign benefits to those Participating
Prowders
i q "Participating Provider" means a physician hn~p~tal or licensed
health professional, practitioner or facll3ty which has entered into a written
agreement w~th SPHN and agrees to comply with the requirements of the Plan and
the reimbursement mechanisms established by City of Denton and the Utilization
review procedures established by SPH~ and approved by City of Denton Hospitals
will sometimes be referred to separately as "Participating Hospitals"
Physicians and other l~censed health professionals and practitioners w~ll
sometimes be referred to as "Participating Physicians"
1 5 "Per Diem Rate" means the rate of payment by City of Denton for one
day of service ~n which a Partqclpattng Patient occupies an ~npatlent acute care
bed in a Participating Hospital
1 6 "PPO Program" means those Covered Services specified as emergency
services ~n the Plan
i 7 "Inpatient Services" means those services provided to a patient after
admission to a hospital and prior to discharge, including, but not limited to
the following
a Sem~-pr~vate room and board,
b Medical, nursing, surgical, pharmacy and dietary services,
c All diagnostic and therapeut3c serwces required by the
Participating Patient and ordered by the attending physician, and physicians'
serwces, which are normally b~lled by the hosp3tal,
d Use of hospital facilities, med3cal social serwces furn3shed by
the hopsltal, and such drugs, b~ologlcals, supplies, appliances and equipment,
as are required by the Participating Patient and ordered by the attending
physician,
e Serwces rendered by the hospital w~thln 24 hours prior to the
Participating Patient's admission as an inpatient, such as outpatient or
emergency services, which are related to the condition for which the
Participating Patient is admitted as an lnpat3ent,
f Administrative services required in prowdlng ~npatlent services
under this Agreement
2 3 Compliance SPHN represents that all of its agreements with
Participating Hospitals contain provisions which require such hospitals to
comply w~th those laws and regualtlons promulgated pertinent to the operation of
an acute care general hospital or acute psych,attic hospital during the term of
this Agreement
2 4 Disciplinary Action SPHN agrees to notify City of Denton promptly of
any d~sclpl~nary proceedings which may be or have been brought against any
Participating Physician by any medical society or hospital acting through ~ts
medical staff, directors, trustees or otherwise and of any such action taken
against h~m by any governmental agency w~thln five days after ~t becomes aware
of such action C~ty of Denton and SPHN will meet to agree upon the continuing
status of such physician w~th the PPO P~oo~am
2 5 Llcepse Requirements SPHN shall assume responsibility for securing
any llcensure or regulatory approval required, if any, to conduct the program
anticipated by th~s Agreement
2 6 Representation C~ty of Denton represents that the Plan ~s being
administered as a self-~nsured payor of health services
ARTICLE III SPHN SERVICE REQUIREMENTS
3 0 Utilization Review Systems SPHN agrees to manage and assure
Participating Provider compliance w~th the utilization rewew systems
established by SPHN and approved by C~ty of Denton and attached as Appendix C
Provisions w~th~n the C~ty of Denton health benefit plan, as included in
Appendix D, w~ll strongly encourage all employees eligible to utilize the
City of Denton health benefit plan to comply with Utilization Review serwces
whether the utilization ~s of participating or non-participating prowders
3 i Responsibilities of Prowders SPHN acknowledges that it and ~ts
individual members and contractors have an independent responsibility to provide
medical care to Participating Patients and that any action made by Participating
Prowders pursuant to SPHN's utilization rewew program ~n no way absolves
Participating Prowders from the responsibility to provide appropriate medical
care to participating Patients
3 2 Cost Containment Efforts SPHN agrees to the appropriate utilization
of such cost containment methods and practices as are consistent with sound
medical practice and ~n accordance with accepted community professional
standards for rendering quality medical care SPHN further agrees to utlllze
procedures and criteria adopted by SPHN and approved by C~ty of Denton to
monitor the necessity and quality of care prowded and to cooperate fully ~n the
development of innovative approaches to cost containment consistent w~th sound
medical practice
3 3 No Guarantee of Ut~l~zatqon SPHN acknowledges that C~ty of Denton
does not warrant or guarantee that Participating Prowders w~ll be utilized by a
Participating Patient or any number of Participating Patients under the Plan,
however, City of Denton w~ll fully ~nform its employees of the advantages of
participating ~n the PPO Program at ~ts expense and will alter ~ts health plan
benefits in a manner presented ~n Appendix D
3 4 Physician/Patient Relationship C~ty of Denton agrees that ~t w~ll
not intervene ~n any way or manner with the rendition of services by a
Participating Provider unless requested by the Participating Patient
i 8 "Outpatient Serwces" means all Covered Med3cal/Hosp~tal Services
other than Inpatient Serwces
1 9 "Day Surgery Serwces" means those serwces prowded by a
Participating Hosp3tal to a Participating Patient during a lnst3tut3onal stay of
less than twenty-four (24) hours which are related to a surgical procedure for
wh3ch payment ~s covered under the Basic Benefits portion of the Plan
i 10 "Utilization Review Program" or "UR" means a program developed and
managed by SPHN and approved by C~ty of Denton to rewew the appropr3ateness of
all institutionalized health care and assure that all institutional care is
delivered at the most cost effective s~te
ARTICLE II LICENSES, CERTIFICATIONS AND REPRESENTATIONS
2 0 PhySician Representations SPHN represents that it has ~nvest~gated
and determined that all the Participating Physlc3ans l~sted in Appendix A and
any additional physicians which SPHN ~nd~cates to C~ty of Denton have become
Part3c~patlng Physicians are duly 13censed to practice the healing arts in the
State of Texas SPHN further represents that 3t agrees to notify City of Denton
~mmedlately of any change ~n such llcensure status
2 1 Hospital Representat3ons SPHN represents that it has investigated
and determined that all the Participating Hospitals listed in Appendix B and any
add3t~onal hospitals which SPHN subsequently indicates to City of Denton have
become participating Hospitals and general hospitals or acute psychiatric
hospitals ~n the State of Texas, that they are currently certified as hospital
providers under the T~tle XVIII (Medicare) of the Social Security Act and are
accredited by the Joint Commission on Accreditation of Hosp3tals (JCAH) as
Hosp3tals and that they w~ll maintain sa~d cert3flcat~ons or accred3tat~ons, and
all other licenses required by law, dur3ng the term of th~s Agreement Evidence
of such licenses, certificates and accreditations shall be submitted to
C3ty of Denton upon request
2 2 Change in Status SPHN shall promptly not~fy City of Denton in
writing of any Participating Hospital's change in status that SPHN 3s or becomes
aware of, Including
a Any action against any of its l~censes, ~ts accreditation by the
JCAH or any successor JCAH,
b Any changes ~n its ownership or bus~ness address,
c Any legal or governmental action 3n~tlated against the hospital
which could mater~ally affect th~s Agreement,
d Any substantial change tn the type of ~npatlent or outpatient
serwces prowded by the hospt~al or in the number of 13censed beds, or
e Any other problem or s~tuatlon that could mater~ally ~mpa3r the
ability of the hospital to carry out the duties and obligation of th~s
Agreement
3 5 Provider Withdrawal SPHN agrees to give City of Denton at least
thirty (30) days prior written notice of a Participating Prowder's w3thdrawal
from the PPO Program SPHN agrees that a withdrawing phys3c~an will continue as
a Participating Physlc3an for at least thirty {30} days after C3ty of Denton
receives written not~ce of the withdrawal SPHN agrees that a w3thdraw3ng
hospital will continue as a Participating Hospital for thirty {30) days after
City of Denton receives written not~ce of the w~thdrawal or unt31 all
Part3c~patlng Patients adm3tted to the hospital as ~npatlents at the time of or
wlth3n th3rty {30) days after receipt of the notice have been discharged,
whichever is longer
ARTICLE IV SPHN CHARGES~ REIMBURSEMENT SCHEDULES AND BILLINGS
4 0 Physician Charges C~ty of Denton agrees to pay to SPHN for Covered
Medical Services furnished by a Participating Physician to Participating
Patients at the rates and under the conditions established ~n Appendix E SPHN
agrees that ~ts Participating Physicians w~ll accept billed charges or such
agreed upon payments contained ~n Appendix E, whichever ~s less, as payment in
full for all serwces covered under C~ty of Denton health benefit plan A
Participating Physician may collect the off~ce visit fee and all non-covered
benefits under the C~ty of Denton health benefit plan at the time that serwces
are prowded The Participating Patient may be b~lled for the deductible and
any copayment beyond the basic office ws~t fee only after the Participating
Physician ~s notlfled by the Plan of the amount payable
4 i Hospital Charges C~ty of Denton agrees to pay to participating
hospitals, as payment ~n full for all ~npat~ent care that amount clarified in
Appendix F
4 2 Payment Schedule Payments will be made by C~ty of Denton or ~ts
designated agent directly to Participating Providers, copayments and
deductibles, w~thln thlrty (30) calendar days of receipt by City of Denton or
its agent of a claim from the Partlclpatlng Provider in such form and containing
such ~nformatlon as required by City of Denton Payment w~ll be accompanied by
an explanation of benefits designating the amount paid and den~ed and specifying
the copayments, deductibles and noncovered serwces Participating Providers
agree not to b~ll the patient for uncovered benefits until the hospital claim
has been adjudicated and paid by C~ty of Denton or ~ts agent
4 3 Physician Billing Forms SPHN agrees that a Participating Physician
w~ll use claim forms acceptable to C~ty of Denton City of Denton reserves the
right to rewew all bills submitted to it by Participating Physlc3ans
4 4 Hospital B~llln~ Forms SPHN agrees that a Participating Hospital
will use its customary b3111ng form, which shall identify the hospital's
usual and customary rate for Covered Hospital Serwces The bill shall
prowde suff~c3ent ~nformatlon to ldent3fy lnpat3ent and outpatient serwces
prowded, charges for such serwces and the number of days a Participating
Patient received such serwces SPHN shall ldent3fy the Per Diem rates for
services prowded prior to City of Denton or ~ts agent receiving the claim
City of Denton reserves the r3ght to review all b~lls submitted to 3t by a
Participating Hospital
4 5 Patient Eligibility SPHN agrees that all Participating Prowders may
determine the eligibility of Participating Patients prior to prowd~ng services
by contacting C~ty of Denton or its agent in the method indicated on the Plan
identification card submitted by the Participating Patient City of Denton
shall not be l~able for payment for services provided by Participating Providers
to persons who are not eligible to receive benefits pursuant to the Plan
4 6 Physician Final Bills SPHN agrees that its Participating Physicians
will make every effort to submit all b~lls for serwces rendered to
Participating Patients within thirty {30) days from the end of the month ~n
which serwce ~s rendered
~ 7 ~osP~tal Final B~lls SPHN agrees that ~t w~ll s.bm~t to City of
Denton all b~lls for Covered Hospital Services rendered to Participating
Patients w~thln forty-five (45) days from the date of discharge of a
Participating Patient or the date of serwce, whichever occurs later SPHN may
submit b~lls on an interim bas~s for Participating Patients confined in a
Participating Hospital for more than thirty {30) days
4 8 B~ll~ng Procedures SPHN agrees that its Participating Providers will
comply with reasonable b~ll~ng procedures as required by City of Denton or ~ts
agent Should a claim form be required, such providers w~ll cooperate in
completing such form and will not charge for th~s serwce Nothing herein shall
be deemed to effect such providers' r~ghts and obligations with respect to third
party payors other than C~ty of Denton
4 9 Charges Not Allowed In the process of utilization rewew, SPHN may
determine that hospital care for a Participating Patient ~s not medically
necessary SPHN shall ~mmed~ately communicate such determination to the
appropriate Participating Prowder and C~ty of Denton Neither City of Denton
nor the Participating Patient shall be liable for any charges related to
serwces provided after receipt by e~ther the Participating Provider or City of
Denton of the not~ce of lack of medical necessity After being notified by SPHN
that City of Denton ~s not liable for continued hospital care, such patient may
voluntarily elect to continue recelwng such care and to pay for the receipt
thereof If City of Denton w~shes to pay for care den~ed by SPHN as being not
medically necessary, it may do so
4 l0 Hospital Day of Serwce A day of serwce shall be b~lled for each
Participating Patient who occupies an inpatient hospital bed at 12 O0 midnight
A day of service also may be b~lled if the Participating Patient ~s admitted and
d~scharged during the same day prowded that such admission and discharge is not
within 24 hours of a prior discharge
4 11 Plan Interpretation City of Denton shall have the sole
responsibility for the determnatlon and interpretation of the requirements of
the Plan SPHN shall have the r~ght to submit ~nput to City of Denton's
decision making process All decisions by City of Denton shall be final SPHN
agrees that ~t and all its Participating Providers will be bound by the
decisions of City of Denton on the Plan
4 12 Other Provisions SPHN may recruit prowders of health care other
than physicians and hospitals Such providers will be l~sted ~n an Appendix G
along with their agreed-upon fee schedule which shall be separately approved by
C~ty of Denton All requirements imposed by this Agreement on Participating
Prowders w~ll be adhered to by such other providers unless so noted ~n Appendix
G
ARTICLE V PHYSICIAN AND HOSPITAL COORDINATION OF BENEFITS
5 0 Permission SPHN agrees that its Participating Prowders w~ll g~ve
their permission and assistance to C~ty of Denton upon request for purposes of
coordinating benefits w~th other carriers or group health ~nsurance benefit
plans
5 i Primary Payor If, under applicable ~ndustry standards for
coordination of benefits, City of Denton is the primary payor, then
Participating Prowder compensation w~ll be on the bas~s specified herein
5 2 Other Than Primary Payor If, under applicable industry standards for
coo-d,rat~on of benefits, ¢~ty o~ Denton ~s other than the pr~ma~y p~yor,
payments to the Participating Prowders are not computed on the basis specified
here~n, then any further payments to the Participating Prowders from C~ty of
Denton or Participating Patient w~ll not exceed an amount which, when added to
amounts payable by the primary payor, equals the amount which would have been
due if C~ty of Denton had been the primary payor
5 3 R~ht of Recovery Nothing contained herein shall restrict or other
wise affect the rights or obligations of the Participating Providers with
respect to compensation from third party payors other than City of Denton
ARTICLE VI MEDICAL RECORDS AND CONFIDENTIALITY
6 0 Physician Maintenance of Medical Records SPHN agrees that ~ts
Participating Physicians will maintain such records and prowde such ~nformat~on
to C~ty of Denton as required by C~ty of Denton ~n accordance with this
Agreement or pursuant to applicable law
6 1 Hospital Maintenance of Medical Records SPHN agrees that
Participating Hospital w~ll maintain w~th respect to each Participating Patient
receiving Covered Hospital Services a medical record ~n such form, containing
such information, and preserved for such time period{s) as are required by the
rules and regulations of the Texas Department of Health, the Federal Medicare
Program and the Joint Commission on Accreditation of Hospitals
6 2 Property of Hospital It is understood that, except as expressly set
forth in this Agreement, the medical records of a Participating Hospital w~ll be
and remain the property of Hospital and w~ll not be removed or transferred from
such hospital except in accordance with applicable laws and general hospital
policies, rules and regualt~on relating thereto
6 3 Access to Medical Records SPHN agrees that ~ts Participating
Prowders w~ll prowde any duly designated third party representing City of
Denton or SPHN with reasonable access to the medical records of a Participating
Patient maintained by such prowders during the term of th~s Agreement and
thereafter for a per~od in conformance with state law The release or
d~sclosure of patient records established in any provision of this Agreement
w~ll be in compliance w~th all laws
6 4 Confldent~al~lty of Medical Records SPHN agrees that ~ts
Participating Prowders w~ll keep confidential information concerning
participating Patients and w~ll not disclose such ~nformat~on to any person
except as authorized by law Th~s confidentiality prowslon will remain in
effect notwithstanding any subsequent termination or expiration of th~s
Agreement
6 5 Con¢ldentlallt~ of Hospital Rates City of Denton agrees not to
disclose the Per Diem Rates negotiated between SPHN and C~ty of Denton to anyone
outside of City of Denton unless required by law or authorized by SPHN
6 6 Confidentiality of Information SPHN may, from t}me to time, receive
information f~lom City of Denton which C~ty of Denton des3gnates ~n writing as
"C~ty of Denton Pr3vate" SPHN agrees that such information shall be kept
confidential and shall not be disclosed to any person except as authorized ~n
writing by City of Denton
ARTICLE VII COOPERATION
7 0 C~ty of Denton and SPHN agr.e th.t, to th~ extent compatible w~th the
separate and ~ndependent management of each, they shall at all t~mes maintain an
effective llalson and close cooperation w~th each other in implementing this
Agreement
ARTICLE VIII SPHN FEE
8 0 C~ty of Denton w~ll pay SPHN $2 10 per eligible employee per month
paid monthly The fee w~ll pay for PPO program maintenance and all Utilization
Rewew Process
ARTICLE IX INDEPENDENT RELATIONSHIP
9 0 None of the prows~ons of th~s Agreement are ~ntended to create nor
shall be deemed or construed to create any relationship between C~ty of Denton
and SPHN other than that of ~ndependent ent~t~es contracting w~th each other
hereunder solely for the purpose of effectlng the prows~ons of this Agreement
Neither of the, parties hereto, nor any of their respective officers, directors,
or employees, shall be construed to be the agent, employee or representative of
the other Neither party ~s authorized to represent the other for any purpose
whatsoever without the prior consent of the other
ARTICLE X INSURANCE
10 0 SPHN agrees that its Participating Prowders, at their sole cost and
expense, shall purchase l~abll~ty insurance ~n the amount of Two Million Dollars
($2,000,000 00) for each }ndlwdual institutional claim, Four Mlll~on Dollars
($4,000,000 00) for the ~nst~tutlon's aggregate loss and Two Hundred Thousand
Dollars ($200,000 00) for ~nd~wdual physician claims and S~x Hundred Thousand
Dollars ($600,000 00) aggregate physician claims Such coverage shall be
effective no later than the effective date of th~s Agreement and will remain in
effect thereafter until the termnat~on of the Agreement
ARTICLE XI TERM AND TERMINATION
11 0 ~ This Agreement shall become effective as of November 1,
1987,(the "Effect}ye Date") and shall continue in effect unless and until
terminated in accordance w~th the prowslons of th~s Article
11 i Termination on Anniversary Date No earlier than s~xty (60) days
prior to November 1, 1988, either party may request tn writing that the terms of
this Agreement be modified The parties shall negotiate such request ~n good
faith and ame,nd th~s Agreement pursuant to any resolution If the part~es are
unable to reSOllVe such issues, e~ther party may terminate th~s Agreement as of
such ann~versalry date by g~wng written notice to the other at least thirty (30)
days prior thereto
15 7 Entire Agree~lIa~t This Agreement contains all the terms and
conditions agreed upon by the parties hereto regarding the subject matter of
this Agreement Any prior agreements, promises, negotiations or
representations, e~ther oral or written, relating to the subject matter of th~s
Agreement not expressly set forth in th~s Agreement are of no force or effect
IN WITNESS WHEREOF, City of Denton and SPHN have caused th~s Agreement
to be signed and delivered by their duly authorized officers, all as of the date
f~rst herelnabove written
CTTV FIK DENTON $OUTHWFAT PRFFFRRED HEALTH NETWORK, tNC
Date /o - P-Y-J'7 Date /49-~-~°~
Attach A
[] .~ ~l Ditto MIo#a.I M M D Geppe~t Oonlel J M D Slle~el POUI M D
~e,T~ma*L MD 84~W Ul~cheflSl
!
Hole N~hon Da~lfl M D Oluok Aobe. N, M D Dovl, ,,adfo,d k M D ~ Dallas
Dameron Zech C III M D C:a~ Poul ]1 M D MayQbb Vlqlll M III M D Thompton Robed D M D
Hawkins William C M D Bakos, Sharon M, M D Smith RIQhard C M D DERMATOLOGY
Gray .lames H M D RADIATION ONCOLOGY Lane R Ward M D Goldsfeln L Michael M D
Hawk Thomas P M D lKIdfleld John S M D Patroon R Don M D Hoffmon William W M D
Herman Wesley K M D Collier Richard I M D Smith Betram L Ill M D Hud George E Jr M D
Kay Dennis B M D Soruggs goberl p Itl M D Talktngton Clement M M D MoCrae William N M D
Llppas, John M D Senze~ Nell N M D Vanderpool David M D Rellly T Philip Jr M D
Phelps William M O Wilbanks Cftc L Jr M D $chnltzer Ben M D
Slusher Norman M D RADIOLOGY DIAGNOSTIC Winter IV John W M D S~hoenvogel Rob~rl C M D
Snyder William M D Amdl Jerome N M D Scott T~oy W III M D
Stonfleld Eunloe F M D Buff[in William J M D SUROERY HAND Shannon Adhur W M D
Uhr BonyW MD Surpo RoberlP, MO CaNer PeterR MD Todd EugeneR MD
Whflaker R Roy M O Code Samuel H Jr IA D DIVelIo Arnold V M D Ware Elgin W M D
Coldwell Joe II M D Flatt Adraln E M D
OPHTHALMOLOGY RETINA & VITREOUS Diamond Nomlan G M D Lank~ord L Lee M D
Nuang Chung En M D Evans James B, M D Zehr David J M D [] D~,~I toll
Den a~ ~ ~6~t {8t~) 3~3 1519 l~--n n ~S ~nrl~n~l ~
UROL~Y
Garland ~ 7~2 ~t4}
Specialty Physicians Whlflaker John M D ~Garland o.,,on. ~ 7~42 1214) 272 341t
Home JoAIlene MD DeSofo TX 75115 ~14) 223 0130 i~ ~~~~
,0., AJ, M, ~ D
NEUROLOGY ~C~III~ 6t8 Clara Barton Suite 1
Ham Stove~ · M D OUNCANVI~ Oarlon~ TX 7~42 {2141272~t ~bane C Frank M O
ENDOCRINOLOGY $1mt Mlch.el N M D Thellen George g III M O
Caltaneda Svangellna M O t~ W ~llege Ave Sulle ~ ~302 Lone SI SuSie 7~ ~ ~ ~r
NEPHR~Y Gra~vlne TX 7~t (St~ 48t-5~3 Irving ~ 7~t [2t4} 2~ 2~
OPHTHALMOLOGY Speclal~ Physicians Dickey ~llzabeth S M D
HaleyJohnM MD 2t0~N MacArlhurBIvd Sulle214~ I~
I ! Specialty Physicians FAMItY PRACIICE
SURGERY GENERAL ~ Ha~,Ja~kA MD
~ Grapevine FAMILY PRACTICE Huggln, Sam M D Lonoo,f,, ~ 75~ [2~] 224 ~
,~UZU~.~i.~ 2~0t N MacAdhur Sulle2~4 Rain Thomo~E MD
[] Mesqmte [] Piano [] Pilot Point [] Richardson
Primary Care Physicians Primary Care Physicians Primary Care Physicians Prlmo~y Care Physicians
FAMILY PRACTICE ~MILY PRACEICE FAMILY PRACTICE
INTERNAL MEDICINE Leasing W Gregory M D Gerehon J Robert D O Bonnet David G M D
Williams DavldG MD 5509PleasanlValleyDrlve Sulle4OO t14E Ubedy t02t Newberry
t900 Cains Dr Sulle t38 Pla~o TX 75023 (2t4) 596.95t t Pilot Polnl 1X 76258 (817) 68~55t t Richardson TX 75080 (2t4} 235 83t t
Mesqulle 1)( 75150 [2t4) 6t3-MtS
INTERNAL MEDICINE NTERNAL MEDICINE Brownlng Robert L Jr M D
PEDIAIRICS She~e~ Nenflelh M D Harvey J Dan M D t02t Newberry
Ooqer Moda g, M D 5509 Plemafll ~:~lley, Suite 3~ Trl County Medical Plaza RIchaldson TX 75080 (2t4) 235-83t t
929 N Galloway Sulle ~12t Piano 1)( 75023 [2t4] 595*7272 Hwy 377 Soulh
Mesqulle 1)( 75149 {2t4) 285*8803 Pilot Point TX 76258 Jeffrey~ Thomas E M D
OBSTETRIC~GYNECOLOQy 2077 N Collins
Nu$e Rob®H J M D Ohe~ev ~on~ld W M D Richardson TX 75~80 [2t4] 238 r848
929 N Galloway Rd Suite t2E 37t3 W tSlh St Suite 40t
Mesqulle IX 75149 [2t4) 285*8803 Plar~) 1)( 75075 (2t4) 867-4300 [] Red Oak Lam Samuel $ O M O
2077N ColllnsUl¥d Suite t03
929 N Galloway Rd Suite t2t 37t3 W t51h SI Suite 40t
Mesquite TX75149 [2t4)285.8803 Piano I)(75075 [2t4)867-4300 Rogers SusanR MD
2077 N Coffins
Specialty Physicians PEDIATRICS Richardson TX 75080 (2t4} 238 t848
de VIIleneuve Alan R, M O
SURGERY ORIHOPEDIC 3900 W t51h St Sulle 600 Rumba Noble L M D
Tanamaohl Cary T M D Piano TX 75023 [2t4) 985 t5t0 t02t Newberry D~
Richardson TX 75080 (2t4) 235 831~
Evans Carolyn A M D
__· Midi s~o w tS~h SuRe 203 Wood John K M D
othJall Piano TX 700~0 [2Id) 985-t660 te2t Newberry Dr
Richardson TX 75080 [2t 4~ 235-83t t
j Specialty Physicians OBSTETRICS/GYNECOLOGY
ANESTHESIOLOGY PhllUps Michael S M D
Haggard Uoyd C M D t70t N Colhns Bird Suite 327
Lafemey Jimmy D M D Richardson TX 75080 [2t4) 644 0522
Newsom Te~'y D M D PEDIATRICS
Small Stuart D M D Primary Care Physicians de VRleneuve Alan R M D
CARDIOLOGY FAMILY PRACTICE 3900 W 151h St Suile 600
Snhwadz David A M D Rose Terrance L M D Piano TX 75023 [2t4)985-t5t0
HEMATOLOGY/ONCOLOGY t4OA Ovllla Rd Evans Carolyn A M D
Brooke Ba~yD MD RedOak r~( 75t,54 12r4)22304t2 3900w tSth Sulle203
NEPHROLOGY Specialty Physicians Piano TX 75075 (2t4) 985 t660
FeareR, Andrew Z, M D PATHOLOGY Specialty Physicians
OPHTHALMOLOGY Noteboom Gerard M D GASTROENTEROLOGY
Sohaff Robert M M D Puppala Anlaneya R M D
Primary Care Physicians OFOLARYNGOLOGY GYNECOLOGY
Damlanl KalMeefl K M D Kuhne Robert M M D
INTERNAL MEDICINE Rubenflald Arnold D M D
Xakarta Mahendra M D NEUROLOGY
I408 N 9Ih RADIOLOGy DIAGNOSTIC Hamey John N M D
Mldlofhlan TX 76065 3s;9-0377 Borden Rlnhard Dean M D Walker Jonathan E M D
Omlg Dwight O M D
OPHTHALMOLOGY
S~RGERY GENERAL Lipton Nathan L M D
Hudgins James W M D McGraw Jerry C M D
Moore Sandm V M D
OrOLARYNGOLOGY
SURGERY ORTHOPEDIC Frank Robert J M D
Glidden Geoffrey G M D Hsu Chung sen M D
SURGERY PLASTIC
Damianl Joseph M M D
UROLOGY
Preeman AlanL MD
ALPHABETICAL PHYSICIAN LISTING
t3
Hlnshow Duane D 0 GaHaud KIIgus Andrew H M D Glapevlne Malson James L M D Dallas Owen Sluart F M D Dallas
Hochharg PhylllsE MD DaRo$ Klllafl KennelhC MD Dallas Moyabb Vl~giIM III MD Dallas Owens F;edD MD Dallas
Ho~kelt Short L M D Garloud Klmmerllng I~arold W M D Dallas McAdoms Charles A M O Denlon
HoBman Edward R M O Garland Klaard Conrad L M D Oenlan McOaRree David L M D Dallas
Hollman William W M 0 Dallas Klndbetg ShHley J M D Dallas MoCasklll Bernie M 0 Dallas P
Hogge AmyMD Dallas King $coltr MD Denton McClung ilughL MD Dallas Packard DightonC MO Dallas
Holder David P M D Carrorlon Kingsley William B M O Dallas McC:lure Howard H M D Dallas Paez Padua N M O Richardson
Holladay George E M D Denton Kitchens Lloyd W Jt M D Dallas McOollum Rancid J M D GaHand Palme~ Anthony R M D AHInglon
Holmes Ronald I M D Garland Klein JalRey B M D Garland McConnell John W M D Dallas Polk R Conrad M O Denlon
Hall DanF MD Denlon Knox sallyM MD Dallas McConnell RlchardF Ji MD Arlington Pa~k RandyL MD Denlon
Ham Sloven G M D Denton Honda Janardhon M D Dallas McConnell thomas H M D Dallas Polkas thomas F III M D Dallas
Hoover Billy Brown M O Irving Kosler Robert L M D Dallas McCrae William H M D Dallas Pa~ker William L M D Dallas
Hopkins Challe~ D M D Denlon Kolsanl$ Conslanllne A M D Glapevlne M~ullaugh Michael L M D Dallas Palks Robelll Ji M D Dallas
Hoppenslela Jay M M D Dallas Kanaka John III 0 0 Danlon McFoHond War~en M D AHIngton Parsons Earl Howard M D Irving
Home Ja-Allene M D Denton Kramer Robed I M D Dallas McGehee Frank T M D benlon Palel Jyoll N M D Denlon
Itoslold Golden M D Dallas Krtslalarson John S M O Denton McGowan Bernard M D Arlington Palel N A M D Dallas
HOSE GaryV MD Garland Kuhne RoberlM MD Richardson McGrew Jern/C MD Richardson Polman R Don MD Dallas
Howard Ben K M D Dallas Kukmla Suresh M D Galland McKalg Calvin N M D Arlington Potlelson Fhamas V M D Oenlon
Howard Byron M D Dallas Kurrus F D M D Denlon McKInney James M D Dallas Patton La~ry H M O Richaldson
Howsden F Loller M D Galland McKinney Kevln M O Denton Paulson Roy S M O Dallas
HiU Chunk sen M D Richardson McNobb W Lee M D Dallas Payne Frank C Jr M O Dallas
Huang C:hung En M D Dallas L Melton Jack F M D Dallas Payne Paul M D Dallas
Hubbard SusanJ MD Dallas LatemeyJImmyD MD Piano Melvin JohnN MD Dallas Perolla AlexanderJi MD DunconvUla
Hudgins James W M D Piano Laird W Penno~k M D Dallas Mendelson Michael M D Artlnglan Perkins David L M D Corrollon
Hugglns sam M D hying Lam Samuel B 0 M O Richardson Mennel Robert G M D Dallas Peoyman Ray W M D Richardson
Hughes C David M D Arlington Lancaster James M M D Dallas Monier Alan M D Dallas Peters George N M O Dallas
Hughes Lannle R M D Dallas Lane B Ward M D Dallas Menzer Leon M D irving Pelerson W~lllam A M O Lancasler
Hunl Don G M D Dallas Long Kenneth Charles M O Garland MerHman Richard C M D Dallas Pharo Mllam B M D Dallas
Hunler Davids MD Arliflglan Longdon Deride MD AIllaglan Mewhlnney LogonU MD Dallas Phelps Wllllam MD Dallas
Hard Eric R M O Dallas Lanier Andrew J Jr M D Dallas Meyers Thomas P M D Dallas Phillips Michael S M D Rlchaldson
Hursl Martin L M D Dallas I-onklord L Lee M D Dallas Michaels Douglas B M D Denton Pierce J Rush M D AHInglon
Hurl George E Jr M D Dallas !.aubaoh J Bruce M O Dallas Mlchaelson Paul Stanley M D Dallas Pippen John E Jr M O Dallas
Huse RoberlJ MD Me~ClUHO Louberdala RoberlA MD Richardson Mlllard MarkW MD Dallas Pile Davids MD Dallas
Hyland John W M D Dallas Lawley Wraymon R M D Dallas Miller Alan N M D irving PIllard Calllon D M D Gcapevlne
Low,on L Ray M D Dallas Miller Ervin R M D Loncaste~ Plum George E M D Dallas
Leyden James David M O Corlellon Miller J Hamplan M D Danlon Polndexle~ Craig M O Arlington
~ Leach CharlesR MD Arlington Miller JahnB III MD Dallas Polanco EIIzabelhM MD Dallas
Illya Fawzl A M D Grapevine Ledbeflel Thomas G M D Waxahachie Miller Walter $ J~ M D Denton Poher Daniel E M D Dallas
Ingram Wallace H D 0 Dallas Lee Dwighl A M D Dallas Mitchell Charles D M D Dallas Pombo Jaoquln M D Arlington
Inzer Robert W M D Dallas Lee thomas L M D Arllnglon Mlzer G Lavell M D Denton Pope L Eugene M D Arlington
Lefflngwell thames M D Arllnglan Moody Everelt A M D Hying Porter Louis H Il M D Dallas
Leggefl Kennelh Jr M D Arllnglon Moore H Leslie M D Dallas Pollara Louis A M D Dallas
J Lehnel Anlhony D M D Dallas Moore Philip A M O Grapevine Portman Robert K Ji M D Arlington
Lelman Horberl M D Dallas Moore R Anlhony M D Dallas Porto LHO M D Arhnglan
Jackson Jim D M D Dallas Lelman Blephen M D Rlohaldson Moore Sondra V M O GaHond Piano Poslma Tom W M D Dallas
Jackson John W Jr M D Dallas Lansing W Gregory M D Piano Morchower Gary C M D RIcholdson Pragor Bluce I M D Dallas
Jackson Leele MD DDE Dallas LesSer FledC MD Dallas Morgan JohnR MD Dallas Prengler tlvingD MD Dallas
Jackson William K M D Dallas Leventhal Milton M D Garland Morris Richard E M D Artlnglan Pmsklfl John t M O Dallas
JacobEan Robert M M D Dallas Levy AIRed E M D Garland Mueller S~ephen E M D Lancasler Prestldge Claude B M D Dallas
Jailers John R M D Arllnglon LI Kal T M D Arlington Muncy Paul A M D DaUas Prevost Robert W M O AHlnglon
Je~rey thames E M D Richardson Llchlllar Warren E M D Dallas Murphy Thomas P M D hwng Plltohald David G M D Dallas
Jamberg WIIllamC MD Garland Lleberman ZeligH MD Dallas MurrayConsuelaM MD Dallas Puppala AnJaneyaR MD R~chardson
Jernlgan SamueIC MD hying Llppas John MD Dallas Myers Robert1 MD Dallas Pu~gason lhomasJ MD Arlington
Jlnks Larry A M D Ennls Llpsher Martlyn S M D Dallas Pulman J Michael M D Dallas
Johnson Dennis D M D Dallas Llplon Nalhan L M D Richardson Pyron James I M D Dallas
Johnson Douglas W M D Dallas Livingston Shields 0 M D Dallas N
Johnson Eisa A M D Mesquite Lloyd Robert A M O Hying Nachlmson Harold M D Irving
Johnson Harvey III M D Garland Lockwood Roberl M M D Denlon Nance William fl M D Dallas R
Johnson Richard B M D Dallas Long C thomas III M D Dallas Nelson Thomas H M D Dallas Rogsdole R Michael M O Dallas
Johnson William B M D Dallas Long R Gordon M D Dallas Neubach Paul A M D DaUas Rain Thomas F M D Irving
Johnston Stephen B M D Dallas LOUIS Paler M D Dallas Newield Edgar A M D Dallas Ratnone Frank A Jr M O Arlington
Jones Dudley D M D Arlington Low~y James S M D Dallas Newland Earl F M D Arlington Ramon Vlclor J M D Dallas
Jones R FIIwoud III M D Dallas Loyd R Dan M D Dallas Newman Jose M D Lancasler Ramsay Michael A E M D Dallas
Jones Stephen E M D Dallas Lueoke Percy E Jr M D Dallas Newsom Asa A Jr M D Dallas Ramsay Duncan C III M D Richardson
Jones ~A~yneC MD Rlahafdson Luudke DennlsC MD Dallas Newsom lerryD MD Piano Rank DalaC MD A~linglon
Jordan J Russell M D Dallas Lumry William R M D Dallas Newsome Thomas W M D Dallas Rasmussen Diane M D Arlington
Joseph Richard J M D Dallas Lulermon David L M D Dallas Nichols Hall F M O Hying Rasmussen Kenl R M D Arlington
Jayner Edwin M Jr M D Irving Nlcholson Don M D Gartand Ray Peter C M D Dallas
Junk Anlhany C M D Lanoasler M Nlxon Charles T M D Dallas Razzuk Moral A M D Dallas
Nobles Robert H D 0 Denton Reagan David W M D Lancaster
i Machodo Gaston M D Alllagfon Hah Junk J M O hwng Reddy Nallu M O Dasalo
Macho JuanJ MD Dallas Norwood Jamest MD Dallas Reese MerrtckH MD DaUas
HOgol Dlnesh P M D Denlan Mack Michael Joseph M D Dallas Noteboom Gerard M D Red Oak Rehmel Robert W M 0 Dallas
Kakand Mahendra M D Mldlolhlan MacMaslar Benzol C M D Dallas Nunn Rogo~ D M D Denton Rellly I Philip Jr M D Dallas
DenRanvllle Mqdeley Paul E M D Dallas Reltman Sanford M D Artmglon
Kallam G Bryan M D Atllnglan Magoa Roberl V M D Dallas Rhea Dorian L M O Arlinglan
Kang WendyB MD Dallas Makers Mortise MD Dallas 0 Rlan RogerL MD Dallas
Karam Albert G M D Richardson Ma~o~ William C M D Waxahaohla 0 Brten John C M D Dallas Richards sarna A M D Art~nglon
Katz AndresU MD Dallas Malik AyazH MD Garlaud Oconno~ TerenceM MD Dallas Richmond JohnR MD Dallas
Kay Dennis B M D Dallas Mann Robert W M D AIlington 0 Rellly Pele~ J M D Grapevine Rielz Charles w M D Dallas
Keglavlls Michael J M D Irving Marengo Rowe Alaln M O Dallas Gakes Philllp L M D Richardson Riggs Leonard M D Dallas
Kellson GeraldR MD Irving Markword CharlasG MD Dallas Obalao Bingo MD Denton Rl~lng EmeslF JI MD Art~ngton
Kelley Jared L M D Irving Marshall Mark D M D Dallas O~tay HaUII M D Garland Roach Joseph G M D Dallas
t4
Attach B
SOUTHWEST PREFERRED
} tEALTH NE'I VORK, INC
Southwest Preferred Nealth Network Ilealth Facilities Durable Medical
a locally owned and operated health
care organization is designed to Hospllal$ r~ ~. ~ ,
and
bring you quality health care from Respiratory lherapy
major hospitals and qualffied AHI DgNTON
Southwest Preferred Health network Denton Texas 76201 BAY~)R/FO~TER
Southwest Preferred Health Network Dallas Texas 75206
physicians are board certified or (2[6) 826 7030
board eligible tn their medical
specialities Almost 1,000 doctors BAY~OR ~zvssszw .mZCA~ c~ HOME HEAUH CARE
tn North Texas have added their Dallas Texas 75266
(216) 875 g071 (2[6) 820
hospitals offering inpatient and (for ors
specialized services 1600 West~lleBe Street
SP[~ Providers are dedica~ed ~o (817) ~88
ATFACHMEI~ C
SOUTI~4EST HEALTH PLAN, INC
INDIVIDUAL PRACTICE ASSOCIATION
UTILIZATION REVIEW PROGRA~
Definition of Terms
Criteria - A eomb~natlon of symptoms, vltal slgns, patlent's
physical eondlt~on, age, and dlagnoses that have
been established by IPA as indicative of an
appropriate level of treatment
Ail hospital and professional treatment rendered
by SWHP providers will be reviewed against
established criteria Since medical science ~s
always advancing and the art of Utilization Review
is new, the maintenance of IPA's established
criteria will be a d~namic process Add~tlonally,
slnce patients cannot be completely categorized,
exceptions are expected and will be revlewed
individually by an IPA physician or committee of
physicians, unrelated to the case
Admission - The placement of a patlent into an lnstltutlon for
medical treatment Usage of a hospital's surgical
fac~lltles for one day surgery ~s NOT consldered
an admlss~on, however, placement of a patient
~nto an on going day treatment or day care program
is usually considered an admission by the payor
despite the fact that the patient returns home
each nlght
Pre-Adm~sslon Certlflcatlon The revlew of an intended
admission prior to admission for appropriateness
Many hospitals have ~ncreased their outpatient
facilities, and surgical techniques have advances
now allowing some surgeries or therapies to be
done on an outpatient basis without affecting the
quallty of care UNLESS THE PATIENT'S CONDITION
WARRANTS TREATMENT ONLY ON AN INPATIENT BASIS,
PATIENT CARE SHOULD BE DELIVERED OUTSIDE AN ACUTE
INSTITUTION
Concurrent Review - The establishment of treatment and length
of stay parameters at the t~me of pre-admission
certification and review of the actual care
rendered against established parameters wh~le the
patient ls recelvlng health care Physicians
wishing to change or extend the granted para~eters
on any particular case need to call the IPA
Review Coordinator
Retrospective Review
l) The review of hospital claims against a
computer~zed record established at the time of
Pre-Ad~iss~on Certification or the attendlng
physician's request for change or extension
2) The review, in the aggregate, of a physician's
admissions and treatment patterns.
Inpatient Professional Treatment Parameters - The specialIst
determined to most appropriately serve as
attending physician on a case and the number of
specialties or consultants determined most
appropriate for use on a case and the number of
v1slts appropriate for a specific case
Institutional 1) the level of care (hospital,
nursing home or home health), 2) bed type within
a hospital (ICU, Ward, Rehab ), as well as the
length of stay determined as most appropriate for
a specific case
Physician Advlsor - An IPA physician member who, in accordance
with his/her contract, is serving as a member of
the Utilization Review Committee Physician
Advisors review individual case exceptIons, and,
as a Committee, review the ongoing compliance of
IPA physicians with the utilization Review
program as well as the overall effectiveness of
the program
IPA utilization Review Committee - A Committee appointed by
the IPA Board of Directors to establish and
maintain the utIlization Review program in
compliance with SWHP's contract
SOUT[{WEST NEALTH PLAN, INC
INDIVIDUAL PRACTICE ASSOCIATION
QUALITY OF CARE REVIEW
The IPA Utilization Review Commlttee will also be responsible
for Quallty of Care Review since both are essential components
of good medical care
A Inpatient Review
1 All in-patient records will be reviewed retrospective-
ly with regard to both Ut~llzatlon Review and Quality of
care Review Extensive concurrent review will be l~m~ted
to those patients ~n whom the approved parameters for care,
as determined at the time of admission, have not been
properly followed and/or updated Th~s revlew wlll be on a
case by Gase basls and w~ll entail a complete review of the
patlent record, d~alogue w~th the attending phys~clan, and
appropriate follow-up
2 Inpatient claims which lie w~th~n the establlshed
parameters for a specific dlagnosls wlll also be revlewed
retrospectively From this group, speclflc cases will be
selected for comprehensive revaew on a random basis with
care being taken to assure that these cases represent a
random sample of the diagnostic group belng evaluated The
actual number of charts reviewed will be either 10 cases or
1% of the total, whachever is greater This random revaew
will be conducted on a monthly basas and will be a regular
item of business at the monthly Utilization Revle~
Committee meeting Deficiencies will be taken up with the
attending physician and responses documented Referral
will be made to the Board of Directors, as per the
physician's contract with SWHP, when appropriate
B Outpatient Review
1 All outpatient claims submitted to IPA will be
reviewed retrospectively and comparasons made by diagnosis
agalnst the established criteria for that diagnostic group
Any claim which is at variance with these d~agnosls
specific criteria will be reviewed an toro by the
utilization Review Committee The attending physician wall
be contacted for additional information, if a review of the
outpatient record does not clearly explain the variance in
questIon If the physician ~s not able to satlsfactoraly
explain the variance noted, he will be referred to the IPA
Board of Dlrectors for appropriate disciplinary action
2 Outpatient claims which lie within the established
parameters for a specific diagnosis will also be reviewed
retrospectively From thls group, specific cases will be
selected for comprehensive review on a random basis with
care being taken to assure that these cases represent a
random sample of the diagnostic group being evaluated The
actual number of charts revIewed will be either 10 cases or
1% of the total, whichever is greater Thls random review
will be conducted on a monthly basis and wIll be a regular
Item of business at the monthly Utilization Review
Comm] tree meeting Deficiencies will be taken up with the
attending phys~clan and responses documented Referral
will be made to the Board of DIrectors, as per the
physician's contract with SWHP, when appropriate
C 9ther
1 In addItion, the IPA Utilization Review committee
will conduct focused reviews on areas of concern to the
Committee, based on concerns expressed by members,
physicians, hospitals, or SWHP administration
APPENDIX F
SOUTHWEST PREFERRED HEAL1H N~IWORK
PHYSICIANS COMPENSATION
Surgery 138 O0
Normal Del/C Section 148 00
Medicine 5 00
Anesthesiology 29 50
Radiology 11 38
Radiology Prf Comp 1 64
Pathology 1 23
Pathology Prf Comp I 60
ATfAChHE~fF
Ned/Surg ICU Nursery OB Psych Inter~diateCare
All Saints B 515 950 130 530 -
~! - Denton
~est~ate B 585 990 175 600 _
ArlinEton S ~90 900 120 500
Saylor/ B 59?/695 1~066 12~ 680 319
Univ Center
Baylor / B 290 (inpt)
Rehab
~aylor/ 10~ off of Fee Schedule
Surgt-Care
Baylor/ B 535
~aylor / B 535 105 60
6rapevine
Baylor/ B 535
Wa~ahachie
Children's B 550 2~600 t~0 1,200
Med Center
Flow B 535 900 160 550 250
~arland B ~§0 650 150 550 220
~aston B 250/610/725~ 800 - -
HCA/Midway B 605/650 1,000 1SO 550
Park
Hu$1ey S ~90 900 1~0 500
Riehardson~* B 53§ 1,070 ~68
Irving B 525 825 120 550
ArfA~llf~ F Cont' d
Baylor/parkside
In-Patient paid by SPHN
Adult -
Detox day $300 O0
Rehabilitation day $250 O0
Adolescent -
Detox day $350 O0
Rehabilitation day $300 O0
Out-Patient
Adult -
$2,000 O0 global fee
(exclusive of initial history
and physical professional fee)
Adolescent ("Aftercare") -
Phase I $~0 O0 per day
Phase II $15 O0 per day
Phase III $15 O0 per day
~ajor joint replacement
Requesting amendment to percentage discount
\a rnwlgrid 916
APPEND[X G
Baylo~ Su~g~care
3920 Worth St
Dallas, Texas 75246