Pennsylvania Blue Shield v. Commonwealth, Department of Health

Opinion by

Judge Craig,

In view of provisions of the participating-physician contract of Pennsylvania Blue Shield (PBS), approved by the Department of Health, which stated

when requested, a doctor must substantiate to PBiS’s satisfaction by any mutually accepted method that his usual charge of record is the ■most frequent made to all parties*

may .the department order Blue Shield to refund to a group of physicians a sum representing the excess of the medical -fees which those physicians charged for a medical procedure to their insured patients at a clinic ($155 each) over the fees which those…