Appeal from the Order of the Department of Health and Appeal, No. 995 C.D. 1981, from the Order of the Department of Insurance in the case of In Re: Request for authority to offer an experimental program of dental benefits for certain employees of the United States Steel Corporation under a capitation arrangement with certain groups of participating dentists, docketed to Blue Shield Filing No. 9-W-1980.
Thomas A. Beckley, with him Jeffrey W. Davis, of counsel: Beckley & Madden, for petitioners.
D. Galton Cabot Moss, Assistant Counsel, with him Christine Dutton, Assistant Counsel, and Reed Hamilton, Chief Counsel, for respondent, Department of Health.
Elizabeth S. Babbitt, Assistant Counsel, with her Anthony A. Geyelin, Assistant Counsel, for respondent, Insurance Department.
William E. Miller, Jr., with him Thomas E. Wood and William H. Wood, of counsel, Keefer, Wood, Allen & Rahal, for intervenor.
President Judge Crumlish, Jr. and Judges Mencer, Rogers, Williams, Jr. and Craig. Opinion by Judge Mencer. Judge Palladino did not participate in the decision in this case.
[ 65 Pa. Commw. Page 242]
The Pennsylvania Dental Association (Association) has appealed from the actions of the Pennsylvania Insurance Department and Department of Health which approved a comprehensive dental plan for employees of the United States Steel Corporation (subscribers) submitted by Pennsylvania Blue Shield (Blue Shield). The two appeals have been consolidated for argument. In addition, the Department of Health has filed a motion to quash the appeal from its action.*fn1 We dismiss the motion to quash and affirm the actions of the Department of Health and the Insurance Department.
Blue Shield proposed a group dental care plan whereby the subscribers would be provided with dental care by dentists who would be paid for their services on a "capitation" basis. Each subscriber would agree to designate a dentist to provide comprehensive services, and this dentist would be paid on the basis of the total number of employees by whom he had been
[ 65 Pa. Commw. Page 243]
designated, rather than to be paid on the traditional basis of services actually rendered to the individual subscriber. This plan was submitted to the Department of Health and the Insurance Department for approval pursuant to 40 Pa. C.S. § 6329.*fn2 Both agencies approved the plan, and those approvals were appealed to this court pursuant to Section 763(a) of the Judicial Code, as amended, 42 Pa. C.S. § 763(a). Both appeals allege violations of 40 Pa. C.S. § 6324. Also, the Association alleges that the Insurance Department violated 40 Pa. C.S. § 6325 and Section 507 of the Administrative Agency Law, 2 Pa. C.S. § 507.
The Department of Health's motion to quash is based upon a claim that the Association lacks standing to appeal from the Department's action, since it does not have a direct interest in the plan's approval or disapproval. The Association argues, however, that its interest is immediate and substantial because the approved plan will adversely affect many of its members who, it is ...