University Mednet v. Blue Cross & Blue Shield

710 N.E.2d 279, 126 Ohio App. 3d 219, 1997 Ohio App. LEXIS 5106
CourtOhio Court of Appeals
DecidedNovember 13, 1997
DocketNo. 71172.
StatusPublished
Cited by13 cases

This text of 710 N.E.2d 279 (University Mednet v. Blue Cross & Blue Shield) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
University Mednet v. Blue Cross & Blue Shield, 710 N.E.2d 279, 126 Ohio App. 3d 219, 1997 Ohio App. LEXIS 5106 (Ohio Ct. App. 1997).

Opinion

Abood, Judge.

This is an appeal from a judgment of the Cuyahoga County Court of Common Pleas which denied the application to vacate an arbitration award filed by appellant Blue Cross and Blue Shield of Ohio and entered judgment on the arbitration award in favor of appellee University Mednet in the amount of $14,400,000. Appellant sets forth the following assignments of error:

“I. The lower court erred to the prejudice of defendant-appellant in overruling its motion to vacate the arbitration award and in confirming the arbitration award.
“A. Arbitration award must be vacated when the record shows that the arbitration award gives a double recovery to appellee and therefore is against public policy.
*223 “B. An arbitration award must be vacated when the record shows that the arbitration award gives a double recovery to appellee and therefore is a manifest error.
“C. An arbitration award must be vacated when the record shows that the arbitrators exceeded their authority by not resolving the impact of the award of future damages on the parties’ ongoing business relationship thus making the award ambiguous, indefinite and not final.
“D. An arbitration award must be vacated when the record shows that the arbitrators exceeded their authority by not resolving all outstanding issues submitted to them so that the award is indefinite and not final.
“II. The lower court erred to the prejudice of defendant-appellant in failing to rule on or allow defendant-appellant the opportunity to secure or proffer evidence in support of its motion to vacate the arbitration award.”

The facts that are relevant to the issues raised on appeal are derived from an extensive record that includes, but is not limited to, a 1,470-page arbitration transcript, the parties’ collective bargaining agreement, the parties’ post-hearing briefs, the parties’ subsequent motions to the trial court, various correspondences between the parties, and the parties’ respective appellate briefs.

In 1978, the Euclid Clinic Foundation, an association of physicians, and the insurance provider Blue Cross formed a business organization which would later be called HMO Health Ohio. The Euclid Clinic Foundation subsequently became University Mednet (“Mednet”) and Blue Cross became Blue Cross and Blue Shield Mutual of Northern Ohio, Inc. (“BCBS”). Generally, Mednet provided the medical care for HMO Health Ohio members while BCBS was responsible for the sales activities and marketing of HMO Health Ohio. Initially, the parties operated pursuant to annual contracts with Mednet functioning on a “fee-for-service” basis. However, as their membership base grew in size, the parties began negotiations regarding a joint ownership of HMO Health Ohio. 1

In 1985, Mednet entered into an agreement with BCBS (“the contract”) that was to run through December 31, 1999. The contract, which has been amended from .time to time throughout its existence, provided, among other things, that Mednet would use the plan’s network of physicians as the exclusive providers of all covered medical services provided to members of HMO Health Ohio in an area of eastern metropolitan Cleveland extending eastward to the Pennsylvania border and north of Summit County (the “Cleveland East” region). BCBS would provide the infrastructure to operate HMO Health Ohio in the Cleveland East *224 region, maintain its license, market it, enroll persons as members, and collect premiums from members. The parties agreed to a capitation method of payment whereby BCBS would pay Mednet a flat fee per month for each member entitled to receive health care services from HMO Health Ohio. 2

When the parties originally entered into their agreement, Mednet was a physician-owned, not-for-profit foundation. In February 1989, however, in order to comply with Ohio’s corporate practice of medicine laws, Mednet was acquired and became a wholly owned subsidiary of University Hospitals Health System (“University”), a professional corporation. Although University is in competition with the integrated health care delivery system of which BCBS is a member, this acquisition did not violate the terms and conditions of the parties’ 1985 contract, which contained a “Nonexclusive Participation” provision that states:

“This Agreement in no way restricts BCBS or [Mednet] from participating in other HMO, PPO, IPA or similar plans or arrangements, whether within or without the [Cleveland East] area.”

From 1985 through 1993, HMO Health Ohio’s subscriber base grew and was profitable. Initially, BCBS provided Mednet with its own marketing staff but in 1989 the staff merged into one sales department under BCBS. Regardless of this change, BCBS continued to effectively market HMO Health Ohio pursuant to the parties’ 1985 contract and, by 1993, the membership grew to approximately 68,000 members.

In the summer of 1993, Mednet began considering a move out of Meridia Euclid Hospital, which was affiliated with the Cleveland Clinic Foundation and BCBS. The proposed move would require HMO Health Ohio members to use University Hospital and/or its affiliates, who again were in competition with the integrated health care delivery system of which BCBS is a member. Mednet publicly announced its decision to move in May 1994. By this time, BCBS had already begun forming its own integrated health care system with the Meridia Hospital System. On May 9, 1994, it publicly announced its intention to create and market another health maintenance organization called “Super Blue HMO” to operate in the Cleveland East region. Again, due to a “Nonexclusive Participation” clause, the creation and marketing of Super Blue HMO was not in violation of the terms and conditions of the 1985 contract.

Following these actions by the parties, the relationship between them quickly deteriorated and a bitter public relations battle ensued. On May 6, 1994, BCBS wrote Mednet a letter in which it requested an executive meeting to discuss what it considered to be material breaches of the 1985 contract by Mednet. In the *225 letter, BCBS claimed that Mednet had (1) directed HMO Health Ohio members to providers who do not have an appropriate contractual relationship with HMO Health Ohio, (2) misrepresented the nature of HMO Health Ohio members’ obligation under their subscriber certificates, and (3) otherwise failed to comply with the parties’ 1985 contract.

On May 10, 1994, BCBS sent'another correspondence to Mednet concerning instructions that member service representatives of Mednet were giving to HMO Health Ohio members regarding an advertisement that had been released by Meridia Health Systems concerning the use of Meridia Euclid Hospital by HMO Health Ohio members. BCBS provided with this letter what it considered to be an appropriate response to questions by HMO Health Ohio members concerning whether HMO Health Ohio was pulling out of Meridia Euclid Hospital.

On June 3,1994, BCBS again wrote to Mednet and requested that an executive meeting be held no later than June 9, 1994.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cleveland v. Barnes
2023 Ohio 1888 (Ohio Court of Appeals, 2023)
Mears Harding L.L.C. v. Ferri
2012 Ohio 2878 (Ohio Court of Appeals, 2012)
State v. Frazier
2012 Ohio 1198 (Ohio Court of Appeals, 2012)
State v. McRae
2011 Ohio 6157 (Ohio Court of Appeals, 2011)
Miller v. Management Recruiters International, Inc.
906 N.E.2d 1162 (Ohio Court of Appeals, 2009)
Mahlerwein v. Lakhi, 07 Ca 2 (12-5-2007)
2007 Ohio 6616 (Ohio Court of Appeals, 2007)
Selby Gen. Hosp. v. Kindig, Unpublished Decision (7-17-2006)
2006 Ohio 4383 (Ohio Court of Appeals, 2006)
Handel's Ent., Inc. v. Wood, Unpublished Decision (12-22-2005)
2005 Ohio 6922 (Ohio Court of Appeals, 2005)

Cite This Page — Counsel Stack

Bluebook (online)
710 N.E.2d 279, 126 Ohio App. 3d 219, 1997 Ohio App. LEXIS 5106, Counsel Stack Legal Research, https://law.counselstack.com/opinion/university-mednet-v-blue-cross-blue-shield-ohioctapp-1997.