Bakke Chiropractic Clinic v. Physicians Plus Insurance Corp.

573 N.W.2d 542, 215 Wis. 2d 605, 1997 Wisc. App. LEXIS 1429
CourtCourt of Appeals of Wisconsin
DecidedDecember 11, 1997
Docket97-1169
StatusPublished
Cited by6 cases

This text of 573 N.W.2d 542 (Bakke Chiropractic Clinic v. Physicians Plus Insurance Corp.) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bakke Chiropractic Clinic v. Physicians Plus Insurance Corp., 573 N.W.2d 542, 215 Wis. 2d 605, 1997 Wisc. App. LEXIS 1429 (Wis. Ct. App. 1997).

Opinion

DEININGER, J.

Bakke Chiropractic Clinic, Christianson Chiropractic and Brad J. Smith, D.C., (the providers) commenced separate actions seeking to enjoin Physicians Plus Insurance Corporation (PPIC) from terminating its contractual relationship with each of them. The trial court granted PPIC's motion for summary judgment and dismissed the providers' complaints. The providers claim the trial court erred in determining that the Wisconsin Fair Dealership Law (WFDL) did not apply to their contractual arrangements with PPIC. As did the trial court, we conclude that the WFDL does not apply on the present facts. We therefore affirm the order.

BACKGROUND

Physicians Plus Insurance Corporation (PPIC) is a health maintenance organization (HMO) insurer. See Chapter 609, Stats. HMO insurers must make "comprehensive health care services performed by providers selected by the [HMO]" available to enrolled participants, in exchange for predetermined periodic fixed payments from the participants. Section *609 609.01(2), Stats. In 1987, the Wisconsin Legislature enacted measures that required HMOs and other health insurers doing business in Wisconsin to cover chiropractic services. Sections 609.70 and 632.87(3), Stats. Prior to 1997, PPIC met this requirement by entering into provider agreements directly with independent chiropractors and chiropractic clinics, including the three plaintiffs in this litigation.

Under these agreements, the provider was required to provide chiropractic services to PPIC members, and PPIC paid the provider based on a compensation formula set forth in the provider agreement. The compensation formulas varied from contract to contract, and providers were paid on either a "fee for service" basis or a "capitated fee" basis. Under "fee for service," PPIC paid the provider a specified percentage of the provider's "billed charges" for each service performed. Under a "capitated fee" formula, the provider received a fixed amount per PPIC member each month, regardless of the amount of services provided to PPIC members. Under either payment method, the providers were not allowed to seek payment for services from PPIC members unless the member's insurance contract with PPIC called for member co-payments or deductible payments.

The providers are licensed under Chapter 446, Stats., to provide chiropractic services. Each maintains one or more chiropractic clinics within the PPIC service area and provides chiropractic services to both PPIC members and non-members at those clinics. PPIC's contracts with the providers began in 1987-89 and continued through 1996. Each provider agreement allowed for termination without cause by either party upon ninety days prior notice to the non-terminating party.

*610 After discovering that its costs for providing chiropractic services exceeded norms for similar HMO insurers by some seventy-seven percent, PPIC decided to change the way it procured chiropractic services for its members. On December 27,1996, PPIC gave ninety-day termination notices to all of its chiropractic providers. Instead of contracting directly with individual chiropractic providers, PPIC opted to contract with a chiropractic management company, ChiroTech, which agreed to obtain chiropractic services for PPIC members. PPIC agreed to pay ChiroTech on a capitated fee basis for making chiropractic services available to PPIC members. ChiroTech, in turn, entered into provider agreements with chiropractic providers, who were to be compensated according to compensation formulas agreed to by ChiroTech and each provider. ChiroTech offered each existing PPIC chiropractic provider a new provider agreement under which the provider would continue to provide chiropractic services to PPIC members. Some nineteen chiropractic providers accepted ChiroTech proposals, but each of the plaintiff providers rejected contracts with ChiroTech due to the significantly lower compensation offered for their services.

All of the plaintiff providers have had relationships with PPIC for at least eight years. All three experienced growth in their respective chiropractic practices over the duration of their relationships with PPIC, due in large part to the number of PPIC members treated at their facilities. Each provider claims to have relied on the continuing relationship with PPIC when making investments in new facilities, deciding on clinic locations or hiring additional staff. Specifically, Bakke claims that due to *611 its relationship with PPIC, it expanded its DeForest clinic, employed three new chiropractors, and opened offices in Sun Prairie and Waunakee. Smith claims that instead of locating his practice in McFarland as he originally planned, he located in Madison at the prompting of PPIC, a location which cost him significantly more than the McFarland site. Christianson claims to have purchased existing practices in Spring Green and Mazomanie, bought new equipment, hired additional chiropractors and staff, and committed itself to building a new office building in Mazomanie, all because of its provider contract with PPIC. None of the providers claims, however, that any specific location or personnel are devoted exclusively to providing care for PPIC members, nor is there any evidence that PPIC coerced the providers into making these financial commitments.

In order to prevent PPIC from terminating the provider agreements, each provider filed a complaint in the circuit court seeking an injunction, declaratory judgment and damages against PPIC. The trial court consolidated the three cases. After concluding that the WFDL did not apply to the relationships in question, the court granted! PPIC's motion for summary judgment and ordered the providers’ complaints dismissed. The providers appeal the order dismissing their complaints.

ANALYSIS

a. Standard of Review

The parties stipulated in the trial court that there were no material facts in dispute and that disposition on summary judgment was appropriate. The only *612 dispute, therefore, is whether the trial court was correct in concluding that the WFDL does not apply to the agreements between the providers and PPIC. The application of the WFDL to undisputed facts involves a question of law which we decide de novo. Bush v. National School Studios, Inc., 139 Wis. 2d 635, 646, 407 N.W.2d 883, 888 (1987).

b. The Wisconsin Fair Dealership Law

In .1974, the Wisconsin legislature enacted the WFDL to "protect dealers against unfair treatment by grantors." Section 135.025(2)(b), Stats. A "grantor" is an entity that grants a "dealership" to a "dealer." Sections 135.02(2) and (5), Stats. The statute prohibits a grantor from terminating, canceling, failing to renew or substantially changing the competitive circumstances of a dealership agreement without good cause. Section 135.03, Stats. If a grantor violates the WFDL, the dealer may seek damages and injunctive relief. Section 135.06, STATS.

The most frequently litigated issue regarding the WFDL is whether a specific business relationship falls within the WFDL's definition of "dealership." Bush, 139 Wis. 2d at 646, 407 N.W.2d at 888.

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Bluebook (online)
573 N.W.2d 542, 215 Wis. 2d 605, 1997 Wisc. App. LEXIS 1429, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bakke-chiropractic-clinic-v-physicians-plus-insurance-corp-wisctapp-1997.