Kartell v. Blue Shield of Massachusetts, Inc.
United States Court of Appeals for the First Circuit
749 F.2d 922 (1984)
Blue Shield of Massachusetts (defendant) paid physicians directly for treating its subscribers, but required participating doctors to accept its payment as payment in full and never separately bill patients — a "ban on balance billing." Virtually all Massachusetts physicians participated, and Blue Shield covered nearly 74% of privately insured state residents. Dr. Kartell and other physicians (plaintiffs) sued, claiming the ban restrained trade under § 1 of the Sherman Act and created unlawful monopolization under § 2. The district court agreed that the payment-in-full requirement violated § 1 because it prevented physicians from charging more for costlier services. Blue Shield appealed.
Whether an insurance company's requirement that participating physicians not engage in balance billing violates federal antitrust law.