Appeal from the Order of the Commonwealth of Pennsylvania, Department of Health, in case of Re: Request for Approval of Amendments to Blue Shield Regulations for Participating Doctors, dated October 22, 1981.
Thomas A. Beckley, Beckley & Madden, for petitioner.
Christine S. Dutton, with her Ruth M. Siegel, for respondent.
William E. Miller, Jr., with him William H. Wood and Thomas E. Wood, of counsel, Keefer, Wood, Allen & Rahal, for intervenor.
President Judge Crumlish, Jr. and Judges Williams, Jr., Craig, MacPhail and Doyle. Opinion by Judge MacPhail.
Pursuant to the provisions of 40 Pa. C.S. § 6324(a), Pennsylvania Blue Shield (PBS) submitted to the Pennsylvania Department of Health (DOH) for approval certain amendments to its regulations for health service doctors who participate in PBS's professional health service plans. After publication of the required notice and an informal conference, DOH approved some but not all of the proposed amendments.
The Pennsylvania Dental Association (PDA) filed a petition for review in this Court*fn1 challenging the
approval by DOH of the amendment to Section D, Prevailing Fee Program, Regulation 4 which provides in pertinent part that:
However, when requested, a doctor must substantiate to PBS that his usual charges to PBS subscribers are not routinely higher than his charges to patients not covered by third party payment plans.*fn2
The excerpted language is followed by a sentence unchanged by amendment which reads as follows:
If a review of a doctor's records indicates any usual charge of record is not valid, PBS may use this additional information in ...