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RUDOLPH v. PENNSYLVANIA BLUE SHIELD

717 A.2d 508 (1998)

Joseph P. RUDOLPH, M.D., Family Professional Center, P.C., a Professional Corporation and Family Professional Center Laboratory, Appellants, v. PENNSYLVANIA BLUE SHIELD, a Professional Health Service Corporation, Appellee.

Supreme Court of Pennsylvania.

Decided August 21, 1998.

Attorney(s) appearing for the Case

Albert G. Feczko, Jr., Bethel Park, Craig E. Frischman, Pittsburgh, for Joseph P. Rudolph, M.D., Family Professional Center, P.C. and Family Professional Center.

Kevin J. McKeon, Harrisburg, for Pennsylvania Medical Soc. (Amicus Curiae).

Charles P. Falk, for Pennsylvania Blue Shield.

Before FLAHERTY, C.J., and ZAPPALA, CAPPY, CASTILLE, NIGRO and NEWMAN, JJ.

OPINION ANNOUNCING JUDGMENT OF THE COURT

FLAHERTY, Chief Justice.

When a doctor affiliated with Pennsylvania Blue Shield has been denied payment for services by a medical review committee appointed by Blue Shield, what review of the decision is permitted under the contract between the doctor and Blue Shield within the limitations set by the Pennsylvania Health Services Plan Corporations Act?

Between June 1986 and November 1987, Rudolph, a...

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