HomeMy WebLinkAbout1988-089
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RESOLUTION NO.
88 89
RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING THE
EXECUTION OF AN AMENDMENT TO THE PREFERRED PROVIDER AGREEMENT
WITH THE INLAND MEDICAL PROVIDERS FOR HEALTH CARE SERVICES TO
ACTIVE AND RETIRED CITY EMPLOYEES.
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AND
COMMON COUNCIL OF THE
BE IT RESOLVED BY THE MAYOR
6 CITY OF SAN BERNARDINO AS FOLLOWS:
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SECTION 1. The Director of Personnel is hereby author-
ized and directed to execute on behalf of said City an amend-
9 ment to the Preferred Provider agreement with Inland Medical
10 Providers, relating to health care services for active and
11 retired city employees, effective February 1, 1988, which
12 agreement is attached hereto, marked Exhibit nAn, and incor-
13 porated herein by reference as fully as though set forth as
14 length.
15 I HEREBY CERTIFY that the foregoing resolution was duly
16 adopted by the Mayor and Common Council of the City of San
17 Bernardino at a reolll i'lr
meeting thereof, held on the
18 21st of
19 wit:
, 1988, by the following vote to
March
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AYES:
Councilmembers F.~~ri'lni'l Rpilly Flnrp~
MAnnslAY p()pp.._T.llnlrlm Mi"p,r
NAYS:
NonA
ABSENT:
Connr.il Mp..mhAr MinoT
~~~$ /
/' City Clerk
(Continued)
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3-3-88
RESOLUTION: AMENDMENT TO PREFERRED PROVIDER AGREEMENT WITH
. INLAND MEDICAL PROVIDERS FOR HEALTH CARE SERVICES TO
ACTIVE AND RETIRED CITY EMPLOYEES
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The foregoing resolution is hereby approved this
, 1988.
~~ ,,/22\/J_J
Mayor of tit- City of Sa~rdino
Approved as to form and legal content:
day of
March
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3-3-88
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AMENDMENT TO PREFERRED PROVIDER AGREEMENT
BETWEEN
CITY OF SAN BERNARDINO AND INLAND MEDICAL PROVIDERS, INC
FEBRUARY 1, 1988
The parties of the original contract stated herein, hereby amend
the physician conversion rates as stated in attached Exhibit A.
INLAND MEDICAL PROVIDERS, INC.:
CITY OF SAN BERNARDINO:
riJ.rJ 22:~
fV1;/l1/ h(,f.d .
~.[ ",LPIX
Date
F~~dt(d-
PO Box 1700
Colton, CA 92324
~~6JY
Date
,
EXHIBIT A.
I. The following Physician Conversion Rates will apply to this
agreement for the period February 1, 1988 to January 31, 1989:
SURGERY
MEDICINE
ANESTHESIA
RADIOLOGY
PATHOLOGY
$140.00
$6.20
$32.50
$12.00
$2.20
GLOBAL OBSTETRICS
Normal Delivery
C-Section
$1,250.00
$1,500.00
II. Inland Medical Provider, Inc member physicians agree to accept
reimbursement at these rates as payment in full for covered services
and agree not to balance bill patients for such services.
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PREFERRED PROVIDER AGREEMENT
This Agreement is made and entered into as of February I, 1987 by and between the
City of San Bernardino, hereinafter referred to as City, and Inland Medical
Providers, Inc. hereinafter referred to as IMP.
RECITALS
Whereas, City maintains free-choice, self-funded health care plans for its employees
and retirees and their eligible dependents, administered by the John Hancock Mutual
Insurance Company.
Whereas, IMP is. in the business of providing medical services including surgery,
anesthesia, radiology, pathology and other treatment and medicine incidental thereto,
and
Whereas, City and IMP desire to enter into a Preferred Provider Organization
Agreement.
NOW, THEREFORE, IN CONSIDERATION of the covenants and promises contained
herein, City and IMP agree as follows:
RATES OF PAYMENT
(A) IMP shall provide medical services to particIpants in City'~ free choice health
care plans and accept as filII payment amounts which equal 90% of the California
1974, Relative Value Study, RVS sche"ule as follows:
Procedure
100% oer unit char2e
90% payment
acceoted
Surgery
Medicine
Anesthesia
Radiology
Pathology
$ 145.00
$ 6.50
$ 35.00
$ 12.75
$ 2.43
$ 130.50
$ 5.85
$ 31.50
$ 11.48
$ 2.19
Global Obstetrics:
Normal Delivery
C-Section
$1,260.00
$1,540.00
$1,134.00
$1,386.00
(B) Neither City nor patients shall be liable for any payment with respect to
charges in excess of these rates.
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(C) City shall be liable only for medical services which are reasonably necessary to
the patient's health and covered as an eligible expense under the City's free
choice indemnity medical plan.
CLAIMS AND PAYMENTS
(A) IMP shall submit to City or to the Claims Payor designated by City any claims
for payment on billing forms which indicate eligibility for payment, diagnosis,
and detail of charges.
(B) Payment shall be made within 30 days of receipt of the billing form, except with
respect to a participant who has eligibility for other insurance benefits in
which case payment shall be made after and in accordance with City's procedures
involving proper coordination of such other benefits with those of City.
NOTICE OF PHYSICIAN PARTICIPATION
(A) IMP will publish and make available to City and John Hancock a list of its
physicians, their addresses and medical specialties.
(B) In order to encourage its employees to utilize the IMP physicians, City will
make this list available to its employees.
(C) The physician's directory/listing will be updated at least Quarterly by IMP.
ELIGIBILITY
(A) City or its insurer John Hancock Life shall issue identification cards to
participants in City's free choice health care plans.
(B) IMP shall verify eligibility and authorization for services by telephoning the
John Hancock Life claims office or claims payor as designated by City.
ADMISSION TO HOSPITALS
(A) When hospitalization of a participant is medically necessary, IMP physicians
shall have the participant admitted to St. Bernardines Hospital in San
Bernardino when possible. However, participants may be referred to any other
hospital for emergencies or to receive treatment or services which are not
available at St. Bernardines Hospital.
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PHYSICIAN-PATIENT RELATIONSHIP
(A) IMP is an independent contractor and shall not in any way be considered an
agent, employee or joint venturer with City or John Hancock Life.
(B) IMP and its physicians shall be solely responsible to participants for care and
treatment provided to participants.
(C) Neither City nor John Hancock Life exercise any control or direction over IMP
physicians or the services they render.
MEDICAL MALPRACTICE INSURANCE
(A) IMP warrants, as a condition of City entering into their agreement, that IMP
shall carry during the term of this agreement adequate Comprehensive Medical
Malpractice Insurance.
UTILIZATION REVIEW
(A) IMP and its physicians shall partIcIpate in a Hospital Utilization Review
Program designated by the City and Jo/1n Hancock Life. A copy of the Utilization
Review Plan is available for review at the City of San Bernardino.
TERM AND TERMINATION
(A)
The term of this Agreement shall be one (I) year beginning February I, 1987 and
ending at midnight on February I, 1988 and shall be automatically renewed for
one (I) year periods unless either party gives the other party 60 days of
notices not to renew. However at any time during the term of this agreement,
either IMP or City may unilaterally terminate this Agreement without cause by
giving the other party at least 60 days written notice.
ASSIGNMENT
This Agreement may not be assigned or in any other manner transferred by either party
without the written consent of the other party.
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PARTIES TO AGREEMENT
(A) This Agreement is between City and IMP directly. This Agreement constitutes the
entire agreement between the parties pertaining to subject matter contained in
it and supercedes all prior and contemporaneous Agreements, representations and
understandings of the parties.
(B) This agreement may be changed only by an amendment signed by the parties.
FOR IMP
BY:
%~/A~a7#c?-
Frank J. Bott. M.O..Presiden
DATE:
April 1, 1987
FOR CITY
Raymond D. Schweitzer
BY:
DATE:
City Administrator
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