§ 6324. Rights of health service doctors.
(a) Admission to plan.--Every health service doctor practicing within the area covered by any professional
health service corporation shall have the right, on complying with such regulations
as the corporation may make with the approval of the Department of Health, to register
with such corporation for such general or special professional health services as
he may be licensed to practice, within that area, but the corporation may, with the
approval of the Department of Health, refuse to place the name of any health service
doctor on its register. Any professional health service corporation may, with the
approval of the Department of Health, remove from its register the name of any health
service doctor after due notice and opportunity for hearing for cause satisfactory
to the corporation. Nothing in this section shall be construed to limit the discretion
of a professional health service corporation to determine the classes or kinds of
services that will be covered under its contracts.
(b) Freedom from control.--Subject to the provisions of section 6322(e) of this title (relating to liability
of corporation limited), a professional health service corporation shall impose no
restrictions on the health service doctors who administer to its subscribers, as to
methods of diagnosis or treatment. The relation between a subscriber, or any of his
dependents, and the health service doctor shall be identical with the relation that
ordinarily exists in the community between a health service doctor and his patient.
Subject to the provisions of subsection (a) of this section, no person shall be permitted
to interfere with the choice or selection by a patient of his health service doctor
after that choice or selection has been made by an adult of sound mind.
(c) Disputes.--All matters, disputes, or controversies relating to the professional health services
rendered by the health service doctors, or any questions involving professional ethics,
shall be considered and determined only by health service doctors as selected in a
manner prescribed in the bylaws of the professional health service corporation.
(Oct. 9, 2008, P.L.1393, No.108, eff. 120 days)
2008 Amendment. Act 108 amended subsec. (a).
Notes of Decisions
Rudolph v. Pennsylvania Blue Shield, 717 A.2d 508 (Pa. 1998).
· cites it 4× “" 40 Pa.C.S. § 6324(c). The fact that state regulation refers such disputes to Blue Shield's bylaws does not alone convert the actions of Blue Shield into that of the state.”
Carlini v. Highmark, 756 A.2d 1182 (Pa. Commw. Ct. 2000).
· cites it 6× “40 Pa.C.S. § 6324(a) and (c) Pursuant to the applicable bylaws, Article X, Disputes and Controversies Involving Doctors, provides: Section 1.”
Pennsylvania Dental Ass'n v. Commonwealth, Dep't of Health, 461 A.2d 329 (Pa. Commw. Ct. 1983).
· cites it 2× “Opinion by Judge MacPhail, Pursuant to the provisions of 40 Pa. C. S. §6324 (a), Pennsylvania Blue Shield (PBS) submitted to the Pennsylvania Department of Health (DOH) for approval certain amendments to its regulations for health service doctors who participate in PBS’s…”
Pennsylvania Blue Shield v. Commonwealth, Dep't of Health, 500 A.2d 1244 (Pa. Commw. Ct. 1985).
· cites it 2× “The rights of doctors in relationship to a professional health service corporation are set forth in 40 Pa. C. S. §6324. 4 The department asserts that its power to approve Blue Shield’s regulations would be useless, if, once ap *13 proved, regulations could be violated or applied…”
Apple v. Commonwealth, Dep't of Ins., 431 A.2d 1183 (Pa. Commw. Ct. 1981).
· cites it 2× “§6325, the dentists’ method of diagnosis and treatment' and the subscribers’ selection of a dentist, 40 Pa. C. S. §6324, and failure to secure Department approval prior to placing the two-tier reimbursement system into effect, and (2) UIPA, including unfair discrimination…”
Kline v. Blue Shield of Pennsylvania, 556 A.2d 1365 (Pa. 1989).
“In so reasoning, the court stated: In 40 Pa.C.S. § 6324(c), the law expressly authorizes health service doctors (as prescribed in the professional health service corporation by-laws) to hear and decide disputes between the doctors and the professional health service corporation.”
Greenstein v. Commonwealth, 512 A.2d 739 (Pa. Commw. Ct. 1986).
“40 Pa. C. S. §6324(a), repealed in part by the Fraternal Benefit Society Code, 40 P.”
RRS Imaging Assocs. Ltd. v. Med. Serv. Ass'n, 49 Pa. D. & C.3d 339 (1988).
· cites it 3× “When this court initially confronted this case, we agreed with defendant’s preliminary objection that *341 the dispute should first be heard by defendant’s Medical Review Committee, which is the mechanism established by 40 Pa.C.S. §6324(c) and Article X of Blue Shield’s By-Laws.”
Rudolph v. Pennsylvania Blue Shield, 679 A.2d 805 (Pa. Super. Ct. 1996).
“3 Based on the foregoing, we find that parties aggrieved by an adverse determination of a professional health corporation’s dispute review committee, promulgated pursuant to 40 Pa.C.S. § 6324(c), may not seek de novo review of that determination.”
Pennsylvania Dental Ass'n v. Commonwealth, 398 A.2d 729 (Pa. Commw. Ct. 1979).
· cites it 2× “40 Pa. C.S. §6324(b) provides: [A] professional health service corporation shall impose no restrictions on the health service doctors who administer to its subscribers, as to methods of diagnosis or treatment.”
Pennsylvania Dental Ass'n v. Med. Serv. Ass'n, 32 Pa. D. & C.3d 380 (1982).
· cites it 5× “1063, as amended, 40 Pa.C.S. §6324(b), imposes illegal restrictions on health service doctors as to their methods of diagnosis and treatment.”
Carlisle Pediatric Ctr. v. Med. Servs. Ass'n, 40 Pa. D. & C.3d 250 (1986).
· cites it 5× “Subsequent to the fifing of the complaint, a hearing was conducted by the medical review committee as provided for in 40 Pa.C.S. §6324. The review committee reduced the amount of the overcharge from over $54,000 to $29,040 and PBS continued to *252 withhold payments until the…”
— 40 Pa. Cons. Stat. § 6324(C) — 1 case
— 40 Pa. Cons. Stat. § 6324(a) — 4 cases
Carlini v. Highmark, 756 A.2d 1182 (Pa. Commw. Ct. 2000).
“40 Pa.C.S. § 6324(a) and (c) Pursuant to the applicable bylaws, Article X, Disputes and Controversies Involving Doctors, provides: Section 1.”
Pennsylvania Dental Ass'n v. Commonwealth, Dep't of Health, 461 A.2d 329 (Pa. Commw. Ct. 1983).
“Opinion by Judge MacPhail, Pursuant to the provisions of 40 Pa. C. S. §6324 (a), Pennsylvania Blue Shield (PBS) submitted to the Pennsylvania Department of Health (DOH) for approval certain amendments to its regulations for health service doctors who participate in PBS’s…”
Greenstein v. Commonwealth, 512 A.2d 739 (Pa. Commw. Ct. 1986).
“40 Pa. C. S. §6324(a), repealed in part by the Fraternal Benefit Society Code, 40 P.”
— 40 Pa. Cons. Stat. § 6324(b) — 4 cases
Apple v. Commonwealth, Dep't of Ins., 431 A.2d 1183 (Pa. Commw. Ct. 1981).
“§6325, the dentists’ method of diagnosis and treatment' and the subscribers’ selection of a dentist, 40 Pa. C. S. §6324, and failure to secure Department approval prior to placing the two-tier reimbursement system into effect, and (2) UIPA, including unfair discrimination…”
Pennsylvania Dental Ass'n v. Commonwealth, 398 A.2d 729 (Pa. Commw. Ct. 1979).
“40 Pa. C.S. §6324(b) provides: [A] professional health service corporation shall impose no restrictions on the health service doctors who administer to its subscribers, as to methods of diagnosis or treatment.”
— 40 Pa. Cons. Stat. § 6324(c) — 10 cases
Rudolph v. Pennsylvania Blue Shield, 717 A.2d 508 (Pa. 1998).
“" 40 Pa.C.S. § 6324(c). The fact that state regulation refers such disputes to Blue Shield's bylaws does not alone convert the actions of Blue Shield into that of the state.”
Carlini v. Highmark, 756 A.2d 1182 (Pa. Commw. Ct. 2000).
“40 Pa.C.S. § 6324(a) and (c) Pursuant to the applicable bylaws, Article X, Disputes and Controversies Involving Doctors, provides: Section 1.”
Kline v. Blue Shield of Pennsylvania, 556 A.2d 1365 (Pa. 1989).
“In so reasoning, the court stated: In 40 Pa.C.S. § 6324(c), the law expressly authorizes health service doctors (as prescribed in the professional health service corporation by-laws) to hear and decide disputes between the doctors and the professional health service corporation.”
Pennsylvania Blue Shield v. Commonwealth, Dep't of Health, 500 A.2d 1244 (Pa. Commw. Ct. 1985).
“The rights of doctors in relationship to a professional health service corporation are set forth in 40 Pa. C. S. §6324. 4 The department asserts that its power to approve Blue Shield’s regulations would be useless, if, once ap *13 proved, regulations could be violated or applied…”
RRS Imaging Assocs. Ltd. v. Med. Serv. Ass'n, 49 Pa. D. & C.3d 339 (1988).
“When this court initially confronted this case, we agreed with defendant’s preliminary objection that *341 the dispute should first be heard by defendant’s Medical Review Committee, which is the mechanism established by 40 Pa.C.S. §6324(c) and Article X of Blue Shield’s By-Laws.”
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