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Thomas v State Farm Mutual; (COA-PUB, 4/20/1987; RB #1038)

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Michigan Court of Appeals; Docket No. 87996; Published  
Judges Wahls, R.B. Burns, and Warshawsky; Unanimous; Per Curiam  
Official Michigan Reporter Citation:  159 Mich App 372; Link to Opinion alt   


STATUTORY INDEXING:    
Providers Entitled to Charge Reasonable Amount for Services [§3157]  
Prohibition Against Charging No-Fault Insurers More Than Uninsured Patients [§3157]

TOPICAL INDEXING:
Not Applicable    


CASE SUMMARY:  
In this unanimous per curiam Opinion relying upon the previous decision in Dean v Auto Club Insurance Association (Item No. 791), the Court of Appeals held that a physician who participates in Blue Cross/Blue Shield cannot seek additional payment from a no-fault insurer over and above that received from Blue Cross/Blue Shield. In this particular case, plaintiff’s treating physician was a participating physician in Blue Cross/Blue Shield. As such, he contracted with Blue Cross/Blue Shield to accept their payment as payment in full and to not bill the patient for the excess. After Blue Cross paid its share, plaintiff sought to recover the difference from the no-fault insurer. The Court of Appeals held that the Dean decision is on point and dispositive of the issues. Therefore, summary disposition in favor of defendant was appropriate.


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