Court Opinion

ID: 9693307
Source: CourtListenerOpinion
Date Created: 2023-08-25 16:36:18.982985+00
Date Added: 2024-06-11T12:04:40.316853
License: Public Domain

Mackenzie, J.
(concurring). I am constrained to agree with the majority’s holding that the record before us contains insufficient evidence that the moratorium was the result of a combination to support the trial court’s finding of a violation of MCL 445.701; MSA 28.31. I do not, however, endorse all of the reasoning which the majority proffers in support of that result.
On cross-appeal, plaintiffs argue that Dr. Desgranges’ participation agreement with defendant was unconscionable and void because it violated MCL 550.310; MSA 24.600, which provided in part:
*246"A nonprofit medical care corporation shall not impose restrictions on the doctors of medicine, doctors of osteopathic medicine, or doctors of surgical chiropody or podiatry, or doctors of chiropractic, who treat its subscribers as to methods of diagnosis or treatment. The private physician-patient relationship shall be maintained and the subscriber shall at all times have free choice of doctor of medicine, doctor of osteopathic medicine, or doctor of surgical chiropody or podiatry, or doctor of chiropractic.”
Plaintiffs argue that, in view of the foregoing provision, the trial court erred by denying them declaratory and injunctive relief. The majority rejects that argument in view of Mich Ass’n of Psychotherapy Clinics v Blue Cross & Blue Shield of Michigan, 101 Mich App 559, 571-573; 301 NW2d 33 (1980), modiñed in part 411 Mich 869; 306 NW2d 101 (1981). Whether or not that case was correctly decided, plaintiffs’ claim for declaratory and injunctive relief is now untenable because MCL 550.310; MSA 24.600 was repealed by 1980 PA 350, the Nonprofit Health Care Corporation Reform Act, effective April 3, 1981. The analogous provision of the new act is MCL 550.1502(3); MSA 24.660(502)(3), which provides:
"A health care corporation shall not restrict the methods of diagnosis or treatment of professional health care providers who treat members. Each member of the health care corporation shall at all times have a choice of professional health care providers. This subsection shall not apply to limitations in beneñts contained in certiñcates, to the reimbursement provisions of a provider contract or reimbursement arrangement, nor to standards set by the corporation for all eontractngproviders.” (Emphasis added.)
The emphasized language evidently permits re*247strictions in participation agreements such as those at issue here.
The record before us contains disturbing evidence that the moratorium unilaterally imposed by defendant bears no reasonable relationship to the need for outpatient psychotherapy clinics and specifically outpatient child psychotherapy clinics. Many of defendant’s subscribers are being relegated to the offices of individual participating psychiatrists at which reimbursement is not possible under defendant’s rules for the multidisciplinary approach to therapy, which approach is generally recognized as preferable in this field. The ostensible reason for the moratorium was to allow time for development of methodologies for determining the need for outpatient psychotherapy clinics, but defendant has since rejected the methodologies developed by the state without proffering any of its own and extended the moratorium indefinitely. The record suggests that the moratorium does not reduce waste or unnecessary treatment, but instead cuts defendant’s costs by discouraging subscribers from utilizing benefits which defendant has contracted to provide.
Fortunately, subscribers and providers will soon have a remedy under the new act. Under part 5 of the act, MCL 550.1501 et seq.; MSA 24.660(501) et seq., defendant was required to develop a provider class plan which met, among other requirements, those of MCL 550.1504(1); MSA 24.660(504X1):
"A health care corporation shall, with respect to providers, contract with or enter into a reimbursement arrangement to assure subscribers reasonable access to, and reasonable cost and quality of, health care services, in accordance with the following goals:
"(a) There will be an appropriate number of providers *248throughout this state to assure the availability of certificate-covered health care services to each subscriber.
"(b) Providers will meet and abide by reasonable standards of health care quality.
"(c) Providers will be subject to reimbursement arrangements that will assure a rate of change in the total corporation payment per member to each provider class that is not higher than the compound rate of inflation and real economic growth.”
Providers and subscribers will be able to raise the concerns expressed here when the Commissioner of Insurance eventually determines whether defendant is meeting the required goals; see MCL 550.1509, 550.1510, 550.1515; MSA 24.660(509), 24.660(510), 24.660(515).