Pennsylvania Court Rejects Doctors' View That Provider Contracts with Health Insurer Require Payment to Physicians within Reasonable Time. (Recent Court Decisions)
宾夕法尼亚高等法院判决，若合同未规定付款期限，健康保险公司无义务在合理时间内向医疗服务提供者付款，引发对法律系统合理性的批评。
Solomon v. United States Healthcare Systems of Pennsylvania, Inc., 797 A.2d 346,2002 Pa. Super. LEXIS 691 (Pennsylvania Superior Court, April 16,2002) The Pennsylvania Superior Court recently provided ammunition to critics of the U.S. legal system. In an opinion that can only be described as shallow, superficial, ridiculously formal, unrealistic, and too clever by half, the Court held that health insurers are under no obligation to reimburse medical service providers within a time. In fact, under the reasoning of Solomon v. U.S. Healthcare, a contract obligor could presumably take forever before paying for services (provided the contract is silent on the for payment) and not be in breach. Dr. Mark Solomon and his practice group, Regional Neurosurgical Associates, P.C., had an agreement with U.S. Healthcare (U.S. Healthcare is now part of Aetna/U.S. Healthcare) to provide medical services to Aetna subscribers. As with most such health insurance-medical care agreements, the physician provides services to patients and then is to be paid a set reimbursement rate that varies by the type of service provided. According to the Solomon complaint, U.S. Healthcare slow to pay. According to the complaint, U.S. Healthcare was improperly denying some claims and unreasonably delaying payment on others. The plaintiffs sought declaratory relief requiring that they be reimbursed within a time--which plaintiffs defined as 30 days--after providing service and also sought interest on late payments. The trial court rejected their claims and the Superior Court, Pennsylvania's intermediate appellate court, affirmed on appeal. Payment within a time? Sounds reasonable, at least in the abstract. Thirty days as a time? Again, sounds pretty reasonable. The obvious comparison is ordinary household bills. Most consumers are expected to pay within 30 days to the electric company, the phone company, the gas company, the cable television company, and the credit card company. Some of these vendors, particularly the credit card company, will charge a significant late fee and substantial interest rates if the consumer's payment is late. Against this backdrop, the Solomon complaint hardly seems an outlandish request, even if the contract itself is silent about reimbursement deadlines, although a person may argue that 60 or even 90 days is an acceptably for payment in light of the review and verification functions that a health insurer must shoulder. No matter, the Solomon Court cut through any potential Gordian knot as to the exact parameters that might constitute a for payment. Instead, the Court simply held that where a contract is silent regarding for payment, the obligor is subject to no constraints in making a required payment. According to the Court, where a of payment is not specified, a court may not rewrite that agreement and supply the missing 2002 Pa. Super. LEXIS 691 at * 8 Further, [plaintiffs] have not established that an injustice would be prevented by inserting a reasonable time term into the parties' agreement, nor are we persuaded that there is any clear intent by the parties to be bound by such a term. Moreover, we do not perceive that imposition of a thirty day period for payment of claims as suggested by Appellants is essential to a determination of the parties rights and duties. 2002 Pa. Super. LEXIS 691 at * 9 (quoting Hodges v. Pennsylvania Millers Mutual Ins. Co., 449 Pa. Super. 341, 673 A. 2d 973 (Pa. Super. 1996). In making this assessment, the Superior Court is talking gibberish. Courts construing contracts constantly fill gaps in contracts, as well as resolve conflicting language or interpretations and render an interpretation of ambiguous (or purportedly ambiguous) terms. This is not rewriting the contract. It is interpreting the contract. …