Comment on Kartell v. Blue Shield of Massachusetts, Inc.: an antitrust analysis of Blue Shield's reimbursement schemes.
In Kartell v. Blue Shield of Massachusetts, Inc., the First Circuit held that Blue Shield's reimbursement practice known as the "ban on balance billing" did not constitute an unlawful restraint of trade in violation of the antitrust laws. Underlying the First Circuit's decision was deference to what it viewed as efforts by Blue Shield and by the Commonwealth to promote cost containment. This Comment argues that, to the contrary, under an appropriate analysis of antitrust law, the practices employed by Blue Shield did constitute unreasonable restraints of trade on the physicians' service industry in Massachusetts, given Blue Shield's market dominance in the Commonwealth. The Comment also argues that such inhibition of the competitive functioning of this industry is unwise, and that costs should instead be contained by effectuating the antitrust laws and encouraging the development of competitive forces within this industry.
D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics / Q000331:legislation & jurisprudence*; D003132:Commerce; D003363:Cost Control; D004465:Economic Competition / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D007357:Insurance, Physician Services / Q000331:legislation & jurisprudence*; D008404:Massachusetts