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September 18, 2006 at 04:56 PM
Even if one group of health care providers persuades a health plan to exclude another group of providers from its network, that is not necessarily enough to constitute a violation of federal antitrust laws.
A 3-judge panel serving in Salt Lake City on the 10th U.S. Circuit Court of Appeals reached that conclusion in a ruling on Abraham et al. vs. Intermountain Health Care Inc. et al.
The plaintiffs in the case, optometrists, have been trying to persuade Intermountain Health Care, Salt Lake City, Utah, to let them participate along with ophthalmologists on its panel of eye care providers, just as its competitors have.
Utah has let optometrists provide all forms of nonsurgical eye care since 1991, and the optometrists have argued that they could save Intermountain Health more than $400,000 per year if it would add them to its provider network.
Intermountain Health has argued that it prefers to use ophthalmologists in part because ophthalmologists have admitting privileges at hospitals, and using providers with hospital staff privileges is a cost-effective method of assuring provider quality control, Chief Circuit Judge Deanell Reece Tacha writes in an opinion for the court.
