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Solomon v. United States Healthcare System of Pennsylvania, Inc.

Summary judgment in favor of defendants and dismissal of remaining count of plaintiffs' second amended complaint affirmed; court did not err in refusing to insert a "reasonable time" term into parties' agreement or in considering conduct of parties to determine their intent; plaintiffs failed to prove that defendants acted in bad faith simply because some claims were paid sooner than others; no private cause of action exists for enforcing prompt payment provision of Health Care Act.

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OPINION

� 1 Mark P. Solomon, M.D. and Regional Neurosurgical Associates, P.C. appeal from the trial court’s entry of summary judgment against them in addition to dismissal of the remaining count of their second amended complaint. Appellants raise numerous issues, all of which allege error by the trial court in refusing to permit them to proceed on their causes of action. After careful review, we affirm.

� 2 The facts underlying this dispute are not complicated. Appellant Dr. Solomon has an agreement with Appellee Aetna, Inc. to provide certain health care services to Aetna’s subscribers, for which Aetna makes payment. *fn1 Prior to non-emergency treatment by Dr. Solomon or another specialist, however, a subscriber must first obtain an evaluation by his or her primary care physician and a referral to the specialist. This scenario is commonly referred to as “pre-certification.” The subscriber is then evaluated by the specialist, who submits a claim to Aetna. These claims are generally paid promptly at a set reimbursement rate. If further treatment by the specialist is indicated, pre-certification must again be obtained.

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