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READING HOSPITAL v. CAPITAL BLUE CROSS (09/11/69)

decided: September 11, 1969.

READING HOSPITAL
v.
CAPITAL BLUE CROSS, APPELLANT



Appeal from judgment of Court of Common Pleas of Berks County, Jan. T., 1967, No. 129, in case of The Reading Hospital v. Capital Blue Cross.

COUNSEL

Rod J. Pera, with him Samuel A. Schreckengaust, Jr., and McNees, Wallace and Nurick, for appellant.

David H. Roland, with him Walter M. Diener, Jr., George B. Balmer, and Balmer, Kershner, Mogel & Speidel, for appellee.

Wright, P. J., Watkins, Montgomery, Jacobs, Hoffman, Spaulding, and Cercone, JJ. Opinion by Montgomery, J. Hoffman, J., concurs in the result. Spaulding, J., took no part in the consideration or decision of this case.

Author: Montgomery

[ 215 Pa. Super. Page 94]

In this action of assumpsit, tried before Hon. James W. Bertolet, Judge, sitting without a jury, the plaintiff, The Reading Hospital (Reading), received a decision against the defendant, Capital Blue Cross (Capital), in the amount of $1,984.65 for services rendered from May 31, 1965, to August 23, 1965, to Alfred Halsey, a subscriber to Capital's plan of hospitalization. Exceptions to the decision were dismissed and judgment was entered on the decision. This appeal followed.

For the purpose of this appeal the following may be considered as the established facts.

Two Member Hospital Agreements existed between Reading and Capital during the period of the hospitalization of Alfred Halsey at Reading. In the Member Hospital Agreement from July 1, 1962, through June 30, 1965, Reading contracted to provide Capital's subscribers ". . . hospitalization services of the type set forth in subscriber contracts currently being issued by the Plan . . ." and in the Member Hospital Agreement effective July 1, 1965, through June 30, 1966, Reading contracted to provide the subscribers ". . . all hospitalization services customarily rendered to patients by the Member Hospital and not specifically excluded by the subscriber's contract." Under both agreements, Capital agreed to pay Reading for such services, and Reading agreed not to seek payment for them from the subscriber.

The contract between Capital and Halsey is set forth in the Hospital Service Certificate Series J, which provides, inter alia, as follows:

"Article I. Definition of Terms

"1. 'Subscriber' shall mean the person who signed the application card and with whom Capital Blue Cross, hereinafter referred to as 'Blue Cross', enters into a contract, as well as each dependent, if any, listed on the application."

[ 215 Pa. Super. Page 95]

"3. 'Contract' shall mean the contract entered into between Blue Cross and the individual subscriber, and the amendments and riders thereto, under and by virtue of which said subscriber becomes entitled to the benefits of this service. It shall consist of the application of the subscriber, the Hospital Service Certificate, and the ...


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