Blue Cross & Blue Shield v. Commissioner of Insurance

Blue Cross and Blue Shield of Michigan appeals as of right a circuit court order entered on January 20, 1988, affirming a declaratory ruling by the Commissioner of Insurance. We affirm.

Bcbsm, a nonprofit health care corporation, makes payments for medical services directly to participating health care providers, pursuant to agreements entered with them. The agreements stipulate that bcbsm will pay for only medically necessary and appropriate treatments. Due to the large number of claims received, bcbsm does not determine the appropriateness of a claim prior to payment. Instead, it engages in…