Court Opinion

ID: 9693739
Source: CourtListenerOpinion
Date Created: 2023-08-25 16:58:38.373473+00
Date Added: 2024-06-11T18:19:49.817583
License: Public Domain

CRAIG, President Judge,
concurring.
This court should not understate the analogous relationship between the Medicare Act1 and Act 6.2
The Commissioner argues that federal decisions upholding the constitutionality of Medicare’s prohibition of physician balance-billing of the patient/insured supports Act 6’s prohibition of physician balance-billing of a patient/insured.
Of course, there are important differences between the Medicare Act and Act 6, but there are also crucial parallels.
Although in Pennsylvania Medical Society v. Foster, 137 Pa.Commonwealth Ct. 192, 585 A.2d 595 (1991), this court characterized Medicare as a “federal entitlement,” the court in that case approved the Commissioner’s use of Medicare *550rates as guideposts in determining medical providers’ fees under Act 6, as not constituting an improper delegation of rulemaking to the federal government.
Act 6 is indeed aimed at reducing insurance costs by controlling insurance payments resulting from motor vehicle accidents, including medical payments.
Although the scope of Medicare is broader than Act 6, Medicare, like Act 6, is also an insurance program, with the federal government acting as the insurer.
In the Medicare Act, Medicare is referred to as an “insurance program,” 42 U.S.C. § 1395(d), entitling individuals to “insurance benefits.” 42 U.S.C. § 1395(a).
Furthermore, in Whitney v. Heckler, 780 F.2d 963 (11th Cir.1986), the court there examined the background of Medicare and stated:
In 1965, Congress enacted the Medicare program ... This program is divided into two parts. Part A provides reimbursement for covered hospital and related services ... Part B establishes a voluntary program of supplemental medical insurance benefits for certain medical services____
... Medicare enrollees obtain benefits in return for the payment of monthly premiums in an amount determined by the Secretary of Health and Human Services ... These premiums and contributions make up the Federal Supplementary Medical Insurance Trust Fund____
Whitney, 780 F.2d at 965.
Thus, the Commissioner’s reliance upon the Medicare Act in interpreting Act 6 is not misplaced because Medicare, like Act 6, is legislation designed to regulate insurance costs.

. 42 U.S.C. §§ 1395-1395ccc.

. Act of February 7, 1990, P.L. 11, Act No. 90-6.