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No. 118935
| Blakewoods
Surgery Center, |
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Linda
Fausey (517) 484-8545 |
| et
al, |
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Plaintiffs-Appellants,
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| vs (Appeal
from Ct of Appeals) |
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(Ingham
-- Harrison, M)
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Michigan Insurance Commissioner,
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Thomas L. Casey |
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Defendant-Appellee.
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Larry
F. Brya (517) 373-1160 |
Click to view briefs in Adobe format:
Plaintiffs-Appellants' Brief on Appeal>>
Plaintiffs-Appellants' Reply
Brief>>|
Plaintiffs-Appellants'
Reply Brief to BCBSM's Amicus Curiae Brief>>
Defendant-Appellee's Brief on Appeal>>
Blue Cross Blue Shield of Michigan Amicus
Curiae Brief>>
Background
The plaintiffs, a group of physicians, own an outpatient surgery clinic
in Jackson. The plaintiffs applied to enter into a participating care
provider agreement with Blue Cross Blue Shield of Michigan (BCBSM),
but BCBSM denied their application. BCBSM stated that the surgery clinic
had failed to establish "evidencence of need" for the clinic's
services in the Jackson area. The plaintiffs sued the insurance commissioner,
arguing that BCBSM violated the Nonprofit Health Care Corporation Reform
Act and discriminated against their clinic because it is not a hospital.
The act provides that "A health care corporation shall not deny
participation to a freestanding surgical outpatient facility on the
basis of ownership if the facility meets the reasonable standards set
by the health care corporation for similar facilities, is licensed under
part 208 of the public health code ... and complies with part 222 of
the public health code ...." The plaintiffs claimed that, at about
the time BCBSM denied their clinic's application, BCBSM gave provider
status to an expansion of Foote Hospital for similar ambulatory surgery.
The insurance commissioner should order BCBSM to stop using an "evidence
of need" standard, but had failed to do so, the plaintiffs contended.
The insurance commissioner moved for dismissal of the case. In an affidavit,
the commissioner said he would review BCBSM's ambulatory surgery facilities
provider class plan. Ingham County Circuit Judge Michael Harrison granted
the motion and dismissed the case. The judge said the court lacked jurisdiction
because there was no actual controversy pending. He added that the plaintiffs'
remedy was to become involved in the commissioners' review process.
In an unpublished opinion, the Court of Appeals affirmed, agreeing that
there was no actual controversy and that the plaintiffs had an adequate
administrative remedy. The plaintiffs appeal.
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