Weiner v. Hospital Service Plan

13 Pa. D. & C.2d 689, 1958 Pa. Dist. & Cnty. Dec. LEXIS 360
CourtPennsylvania Court of Common Pleas, Lehigh County
DecidedJanuary 20, 1958
Docketno. 3
StatusPublished
Cited by1 cases

This text of 13 Pa. D. & C.2d 689 (Weiner v. Hospital Service Plan) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Lehigh County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weiner v. Hospital Service Plan, 13 Pa. D. & C.2d 689, 1958 Pa. Dist. & Cnty. Dec. LEXIS 360 (Pa. Super. Ct. 1958).

Opinion

Henninger, P. J.,

Plaintiff, a dentist and owner and operator of a dental hospital, so licensed by the Department of Welfare of the Commonwealth of Pennsylvania, brought this action in equity against defendant, more popularly known as Blue Cross, to enjoin discrimination against his hospital and defendant’s subscribers by refusing to pay for services rendered in said hospital.

Plaintiff recites the excellency of his hospital, as attested by words of praise on the part of defendant’s executive director, that the Joint Committee on Accreditation of Hospitals has never approved dental hospitals and therefore will not approve his, that there is dire need for hospital facilities, that defendant has a monopoly .on hospitalization insurance in its territory and that its refusal to recognize his hospital is detrimental to the public health and welfare and is discriminatory.

Plaintiff has attached to his complaint a typical copy of defendant’s contract with its subscribers.

Under section 1 of this contract, defendant provides, in part, that the subscriber may select any “approved hospital”. In section XIY an approved hospital is defined as follows:

“4. Approved Hospital: The term ‘Approved Hospital’ shall mean a hospital which is either,
“(a) A Contracting Hospital of Blue Cross, meaning .a hospital with which Blue Cross has a contract, for the rendering of hospitalization covered by this Agreement, or
[691]*691“(b) An Inter-Plan Hospital, meaning a hospital which has a contract with a Blue Cross hospital service plan approved and licensed as such by the American Hospital Association and which is an eligible participant of the Inter-Plan Service Benefit Bank, or
“(c) A Non-Contracting Hospital, meaning a school infirmary or a hospital which is not a veterans’ or United States Government hospital, but which is approved by the Joint Committee on Accreditation of Hospitals or by Blue Cross.

Defendant filed preliminary objections in the nature of a demurrer. Plaintiff at argument conceded that neither laudatory statements by defendant’s executive nor his statement that plaintiff’s hospital would be approved on a certain date could bind defendant. He relies upon these two propositions: (1) That by law, defendant is required to contract with all hospitals approved by the Department of Welfare, and (2) that, since defendant corporation operates in the public interest, its monopoly can be restrained.

Plaintiff bases its first proposition upon the provisions of section 3 of the Nonprofit Hospital Plan Act of June 21, 1937, P. L. 1948, 15 PS §2851-1303, which reads:

“Any nonprofit corporation, subject to the provisions of this act, may enter into contracts for the rendering of hospitalization to any of its subscribers only with hospitals operated by the Commonwealth, or its agencies, or by political subdivisions, or by corporations organized under the laws of this Commonwealth for hospital purposes, or with such other hospitals as are approved by the Department of Welfare.”

A similar argument was made in Knecht v. Medical Service Association of Pennsylvania, Inc., 27 Leh. 388, in relation to section 3 of the Act of May 12, 1949, P. L. 1261, 15 PS §2851-1503, where, page 392, we [692]*692held that the clause defining services was a clause of limitation and not one of direction.

When we study section 3 of the 1937 act, as above quoted, it is clear that a corporation formed under the act may enter into contracts only with hospitals as defined in that section. There is no provision that they shall or must contract with every hospital answering any one of the descriptions. The additional word only also emphasizes that section 3 is a clause of limitation. Although the word “shall” might, in a proper setting, be interpreted as permissive, the word “may” can never be given the imperative meaning. See Connell v. Kennett Township, 356 Pa. 585, 589; Commonwealth v. A. M. Byers Company, 346 Pa. 555, 561.

We can assume that “such other hospitals” in section 3 includes dental hospitals although there is no mention of dental hospitals in the Act of June 12, 1931, P. L. 510, as amended by the Act of April 12, 1956, P. L. 1460, 35 PS §424-430, which provides for the licensing of nursing homes or private hospitals. Plaintiff therefore would be one with whom defendant has the legal right to contract. It by no means follows that defendant can be compelled to so contract.

Defendant has chosen to limit its services to hospitals: (a) With which it has actually contracted; or (b) with which a similar Blue Cross plan has contracted; or (c) which is approved by the Joint Committee on Accreditation of Hospitals; or (d) which has been approved by Blue Cross. Plaintiff’s hospital admittedly does not come within any of these categories. It is not, therefore, an “approved hospital” for whose services to its subscribers Blue Cross has obligated itself to pay under section 1 of the contract.

It is fair, at this state of the proceedings, to assume that defendant’s contract with its subscribers has at least the tacit approval of thé insurance department as required by section 4 of the act under which defendant is operating, 15 PS §2851-1304.

[693]*693The charge of monopolistic practices raises many questions: (1) Can we take judicial notice that there are many other companies selling hospitalization insurance; (2) is defendant a corporation coupled with a public interest; (3) does an action against defendant as a monopoly lie in our courts; (4) has plaintiff a standing to raise the question of a monopoly.

We know, of course, that defendant does not actually have a monopoly on hospitalization insurance. There are many private business corporations operating in this field. Many persons, while members of Blue Cross, also purchase hospitalization insurance with private business corporations. However, since this case comes to us on demurrer, we do not choose to decide it on the basis of any actual knowledge of our own conflicting with a statement of fact as pleaded. We are assuming, therefore, that defendant actually has a monopoly hold on hospitalization insurance in our neighborhood.

Any such monopoly does not exist by legislative fiat. While an application for incorporation as a nonprofit hospitalization insurance plan requires prior approval by the insurance department (see Nonprofit Corporation Law of May 5, 1933, P. L. 289, as amended by the Act of June 21, 1937, P. L. 1980, 15 PS §2851-4 and 218), there is nothing in the act which limits the number of such corporations in a given locality or which authorizes the insurance department to grant a monopoly to any one such corporation. Any monopoly which may exist arises, therefore, from the unwillingness of others to compete and not from any franchise granted by the State to defendant.

We may further assume, for the purposes of this opinion, that defendant is a corporation with a quasi-public interest, although it has received nothing from the State that is not granted to every other nonprofit corporation. Unlike the Nonprofit Medical Service Cor[694]*694poration Act of June 27, 1939, P. L. 1125, secs.

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Related

Weiner v. Hospital Service Plan
144 A.2d 575 (Superior Court of Pennsylvania, 1958)

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13 Pa. D. & C.2d 689, 1958 Pa. Dist. & Cnty. Dec. LEXIS 360, Counsel Stack Legal Research, https://law.counselstack.com/opinion/weiner-v-hospital-service-plan-pactcompllehigh-1958.