An Open Letter to My Patients Who Have Insurance Coverage Through EMI

It has come to my attention that you have received an email from Educators Mutual Insurance, a company that acts as a third-party administrator for the Utah Public School system (a “self-funded program” supported by all of our tax dollars). I understand this email has advised you to start looking for another orthopaedic surgeon. They have apparently informed you that I will no longer be contracting with them as a physician effective August 5th this year.

This is not a decision I have taken lightly because I highly value all of you as my patients. However, because I care about you as my patients, I can no longer allow EMI to take advantage of all of you by continuing to force you to use ONLY Intermountain Cedar City Hospital (or more exactly, any Intermountain hospital) as the facility where you have your surgical procedures performed, especially when I know that you stand to benefit financially by using Cedar Orthopaedic Surgery Center if you so choose.

It is time for me to tell you about the history of events taking place that have centered largely around Cedar Orthopaedic Surgery Center.

Beginning in 2004, my surgery center enjoyed a contract with EMI that provided you, my patients, with the advantages of surgery at COSC if you so chose. For those of you who did get a chance to enjoy those advantages, you know that my pricing is a fraction of the charges that you would have to pay at Intermountain Cedar City Hospital, or any other hospital for that matter. Consequently, your out-of-pocket expenses would clearly be less as well.

However, in early 2013, COSC was faced with the specter of losing our contract with EMI, which administers your insurance coverage. Despite a conference phone call with EMI administrators at that time, EMI went ahead and made the decision to cancel their contract with COSC, NOT because of any problem it had with COSC, but because of a larger across-the-board discount for medical and surgical services that Intermountain Healthcare offered EMI on the condition that they did not contract with COSC (or any other non-Intermountain facility).

This is a bold-faced case of one business basically bribing another business to not use a certain other business! I did not like it at the time, but I still wanted to offer my excellent services to all of you even though your choice of facilities for services became very limited. I found that even with me as a provider, you still had no choice of surgical facility. For me, this is not acceptable to endorse any longer. I have held out hope that I could prevail upon EMI to “see the light” and re-contract with COSC again. Yet despite my best efforts to help EMI understand the benefits of choice in surgical facilities that I offer to my patients, they remain stubbornly entrenched in their stance of wanting to keep their seemingly across-the-board discounts on services that may or may not be actual discounts because hospital charges generally start out as outlandish and get negotiated down to something slightly less outlandish.

Basically, it simply does come down to “choice”.  With me as a contracted provider, I must maintain that having “choice” of surgical facilities (especially when savings could be so significant) is of supreme importance at this time. Without me as a contracted provider, you simply have “no choice”.

I want you to know that I value you as a patient, and although I will be an out-of-network physician as of next month, you can certainly still use my services. When I am not a contracted provider, I am not restrained by any insurance company requirements. I believe that you will still benefit from continuing with me as your orthopaedic physician both with excellent care and transparent cash surgical pricing as well, especially if you have a high deductible, which is quite common these days. Many of my surgical prices are well below some of the standard deductibles, and that is one thing Intermountain finds to be a threat to them. Additionally, if you find yourself injured and in the emergency room, you are quite welcome to request me as your orthopaedic physician. I will ALWAYS be able to care for you in an emergency situation regardless of in-panel or out-of-panel status – (435) DEL-CORE. For more information regarding COSC transparent cash options, you may go to delcore.org.

If you find this issue to be rather irrelevant, I apologize for beating my drum and feeling the need to explain my side of the story. However, if you are outraged at the way you are being treated by your third-party administrator and do not want your choice of where you receive surgical treatment controlled by Intermountain’s collusion with EMI, I invite you to contact both the Human Resources officer for your school district or college and the EMI representative Emily Harenberg at (801) 270-2951 or (800) 662-5850, Ext. 2951, eharenberg@emihealth.com.

My best regards,

 

Randy G. Delcore, M.D., Medical Director

Cedar Orthopaedic Surgery Specialty Clinic

Cedar Orthopaedic Surgery Center

 

www.ftc.gov/tips-advice/competition-guidance/guide-antitrust-laws

Cedar Orthopaedic Surgery Center Works With Health Sharing Plans

Do you have a health sharing plan? Cedar Orthopaedic’s transparent pricing tool can work hand-in-hand with health sharing plans to provide affordable care that makes it easy to plan financially for surgeries. Call today at (435) 586-5131 to find out more.

Healthcare Sharing Plans and Cedar Orthopaedic

Health Sharing Plans have stood as a rare exemption to the individual mandate in the Patient Protection and Affordability Act. As a result, some people have chosen such plans as an alternative to traditional coverage for medical and surgical expenses. Cedar Orthopaedic is happy to work with those using these plans. If you’re unfamiliar with health sharing plans, keep reading to learn more about how they work.

What is a Health Sharing Ministry?

People who choose this type of plan for medical and surgical expenses pay a monthly amount in the same way that they would if they had traditional insurance. The monthly payments that participating individuals and families make are managed differently, depending upon the ministry you are using.

One sharing ministry directs participating members to send their payment directly to another individual or family that has submitted bills for a medical need. Another ministry has participating members making their payments to a “share box,” When that ministry receives medical bills and verifies their eligibility for payment through the ministry, they direct participating members to pay from their “share box” to the other members’ secure online “share box” account. The ministry you choose will inform you regarding the way it manages the sharing.

Health sharing ministries have a variety of plans from which to choose. Also, they each have a differing maximum amount you can use to pay for your medical expenses. Some plans allow you to use up to a million dollars for each incident you have. Each plan differs in terms of benefits, but some plans offer perks that mirror those available with traditional health coverage, like stable monthly payments, discounts and out-of-pocket limits.

In most cases, these health sharing plans are open to those who share the common beliefs of the group, typically those of Christianity. Many expect members to abide by Christian beliefs and to practice healthy habits. They generally expect them to abstain from excessive drinking or tobacco use.

Health Sharing Ministries generally provide more patient freedom of choice.

 

There is a video explaining the value of Health Sharing Ministries and the freedom they offer on the home page of the Liberty HealthShare website.

More recently, a type of sharing ministry that caters to employers rather than individuals and families is gaining steam. Although this ministry is a Christian organization, it does not require participants to share this faith.

Do Health Sharing Plans Fall Under the ACA?

Those who choose to cover medical costs through these plans have not been required to pay the tax penalty demanded by the individual mandate because they have been exempt under the law.

The passage of tax reform by Congress in early 2018 included the repeal of the pesky tax penalty associated with the ACA’s individual mandate. Therefore no special exemption should be necessary beginning in January of 2019.

Can I Use my Health Sharing Plan at Cedar Orthopaedic?

Cedar Orthopaedic is an excellent facility to use with a health sharing plan. We offer direct care for injuries and transparent pricing on our orthopaedic procedures. In the event of a joint replacement or other necessary procedures, Dr. Delcore’s transparent pricing tool can help you plan for your upcoming surgery. You will know exactly how much your surgery will cost and can use your health sharing program to plan accordingly. If you are curious about our all-inclusive surgery prices, check out our website price transparency tool. For more information, call us at (435) 586-5131.

 

 

Congressman Chris Stewart Visits Cedar Orthopaedic Surgery Center

Congressman Chris Stewart Visits Cedar Orthopaedic Surgery Center

Dr. Randy Delcore, founder and medical director of Cedar Orthopaedic Surgery Center (COSC) located in Cedar City, Utah, welcomed US Representative Chris Stewart (UT-02) to his facility on November 12.

Delcore talked with Rep. Stewart about a serious challenge the surgery center is facing in its rural environment of southern Utah due to the consolidated delivery and insurance market in which they operate. The nature of the market in which they operate has made it hard for COSC to obtain contracts to perform and be reimbursed for surgical services.

Delcore explained to Rep. Stewart that this situation prevents many residents in the area from enjoying a choice of physicians and the opportunity to have high-quality surgery performed for much more reasonable prices.

As Rep. Stewart visited with Delcore, Terri Hartley, who had just been elected to the Cedar City Council the week before, was also present to listen with interest to Delcore’s description of his surgery center’s challenges. Two local reporters were also present.

The caption for the photo reads:

Daron Pealock, administrator and director of nursing at Cedar Orthopaedic Surgery Center, and Dr. Randy Delcore meeting with Representative Chris Stewart. Photo by Corey Baumgartner from Iron County Today.

This article appeared in the Ambulatory Surgery Center Association’s weekly online “Government Affairs Update.”

COSC Featured in ASC Focus

Five Steps to High-Quality Surgery for Great Prices in Southern Utah

 

Medical tourism involves traveling outside of one’s home locality to receive medical or surgical treatment for a better price and quality than local hospitals and standard insurance coverages currently offer. This route has been an option for many years. as people who are discontent with their health care choices in their own area look elsewhere. While many have thought this option only involved traveling outside the country, domestic medical tourism has been flourishing within the United States. Learn why medical tourism in the United States can be a safer and more affordable option.

Medical Tourism in the United StatesThis form of medical tourism has been popularized by surgery centers within the U.S. that offer transparent cash pricing on their websites with all-inclusive costs for the surgeon’s fee, facility fee, anesthesiologist fee, and even total joint implant fees.

Those living in the Southwestern United States in areas such as Flagstaff, Sedona, or Scottsdale, Arizona may want better choices in price and quality than they can find in their hometowns. So, when facing the need for orthopaedic surgical procedures, they should consider taking the following steps to find a high-quality surgical facility with low bundled cash prices.

  • Check out delcore.org to learn more about our orthopaedic surgery center in Southern Utah.
  • Click the link on the home page that will connect to a page where visitors can click on a body part and find bundled pricing for orthopaedic procedures on that particular body part.
  • For more information and to chat with Randy G. Delcore, MD about your orthopaedic needs, contact Cedar Orthopaedic Surgery Center directly by calling (435) 586-5131 or go to the bottom of the page for contact information and click on the email link to send a secure email.
  • Want more information about your orthopaedic issue? Go to American Academy of Orthopaedic Surgeons website to get extensive, reliable medical information.
  • Want to throw some fun into your surgery travel? Check out all the wonderful activities and tourist destinations available near COSC and learn why Cedar City should be on the top of your list for medical tourism vacation destinations.

Domestic Medical Tourism is a great way to enjoy high-quality, low-cost surgery without an insurance company calling the shots and forcing you into a narrow choice of unnecessarily expensive physicians and facilities. Follow these five steps for a great orthopaedic surgery experience.

Medical Monopolies & Rising Surgery Costs

Cedar Orthopaedic Surgery Center in Cedar City, Utah has options for cash or insurance payment.

How much does the average knee replacement surgery cost – $16,000, $31,000, $90,000? In some markets, it can be all of these. Thanks to medical monopolies across the country, merging hospitals have banded together in order to SUPPOSEDLY bring better care to their patients.

However, these mergers have resulted in skyrocketing health costs, and the quality may be no higher. The more hospitals merge, the less competition in a given area there is. With less and less competition, health care providers can charge insurers anything they want, which in turn, only hurts the patient. Instead of paying more for quality health care, patients and insurance companies pay for larger hospital systems.

The northern Utah market alone sees a cost variation between $5,500 and $11,000 dollars for knee surgery alone. Nearby states like Arizona has a varied market with differences in the Phoenix market over $18,000 while the Tucson market sits under a $5,500 difference. Las Vegas may also see a $5,000 to $11,000 difference in prices for the same surgery.

Additionally, the state of Utah has a very powerful “health care” system that has its own insurance company which does not contract with unaffiliated facilities — that often offer much better pricing. This health system also uses large across-the-board discounts on medical and surgical services to entice other insurers and third-party administrators to avoid contracting with providers that are not affiliated with that system.

There are a number of factors that come into play when you need surgery, including what your own insurance carrier is expected to pay at the local hospital (especially with deductibles being so high these days),  prices at competing facilities, quality comparisons between facilities, and others such as facility location. One essential principle to remember is that high cost does not mean high quality.

Here is a short video that illustrates this very well.

Medibid Explains- The Cost-Quality Paradox in Healthcare from MediBid on Vimeo.

Stand-alone Surgical Centers & Affordable Care

More and more, surgical facilities are making their prices for procedures easier to find. If you know where the cheapest gasoline in town is, why can’t you have the same information for something as important as orthopaedic surgery?

Thankfully there are options in the Southern Utah market for those in Utah, Arizona, California and Nevada for affordable, flat rate orthopaedic surgical treatment. Cedar Orthopaedic Surgery Center isn’t part of a medical monopoly. We publish our flat rates, so you know exactly what you’re paying for your next surgical treatment.

With a fully licensed staff and two state-of-the-art operating rooms, you don’t have to play medical monopoly with hospitals in your area and risk landing on Boardwalk. Our cash prices include everything from surgeon’s fee, facility fee, total joint implants, anesthesia fee and same-day physical therapy. With the state of medicine today, the highest prices certainly don’t mean the best care.

Orthopaedic Surgery Meets Weight Loss

Orthopaedic surgery and weight loss are not often associated in the average person’s mind, and yet as the days of even stricter Medicare regulations are fast approaching, doctors who perform surgery on patients with a high Body Mass Index (BMI) may risk reimbursement cuts from Medicare.

Why?

Obesity is one factor, among several, that can lead to surgical complications, and increase the cost of the surgical episode for patients who are considered obese. To hopefully overcome this obstacle, Randy G. Delcore, M.D., medical director for Cedar Orthopaedic Surgery Center, has found a solution that can put patients on the road to much healthier and happier lives. He has discovered the very innovative Obalon program of weight loss that requires no surgery whatsoever and can assist patients in achieving their weight loss goals and enable them to get the orthopaedic surgery they need to be more comfortable and mobile…big winners when it comes to quality of life.

To learn more about lowering one risk that can come with surgery, go to https://delcore.mystagingwebsite.com/obalon/.

St George News Letter to the Editor

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