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PA. BLUE SHIELD v. PA., DEPT. OF HEALTH

No. 809 C.D. 1984.

93 Pa.Commw. 1 (1985)

Pennsylvania Blue Shield, Petitioner v. Commonwealth of Pennsylvania, Department of Health, Respondent.

Commonwealth Court of Pennsylvania.

November 13, 1985.

Attorney(s) appearing for the Case

Thomas E. Wood, with him, William H. Wood and William E. Miller, Jr., Keefer, Wood, Allen & Rahal, for petitioner.

Christine S. Dutton, Assistant Counsel, with her, Ruth M. Siegel, Chief Counsel, for respondent.

Fred Speaker, Pepper, Hamilton & Scheetz, for Amicus Curiae, Pennsylvania Medical Society.

Thomas A. Beckley, with him, Jeffrey W. Davis and John G. Milakovic, Beckley & Madden, for Amicus Curiae, Pennsylvania Dental Association.

Argued September 11, 1985, before President Judge CRUMLISH, JR. and Judges ROGERS, CRAIG, MacPHAIL, DOYLE, COLINS and PALLADINO.

OPINION BY JUDGE CRAIG, November 13, 1985:

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 PBS'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...

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