Highmark Inc. v. C.L. Voltz, Esq., 163 A.3d 485

Background

Requester sought documents Highmark submitted to the Pennsylvania Insurance Department regarding provider reimbursement rate changes for physical therapy, allergy testing, and venipuncture, and the Department’s response.
The Department denied the request, treating the submissions as confidential proprietary information under RTKL § 708(b)(11); Highmark objected and participated as a direct-interest third party before OOR.
Highmark asserted exemptions under RTKL, and that state insurance statutes (the Accident and Health Filing Reform Act § 309 and the Professional Health Services Plan Corporations Act § 6329) protected the rates because they were filed with the Department and marked confidential.
OOR ordered disclosure, reasoning § 309(c) of the Reform Act protects only payment rates and fees “requested by the Department,” and concluded Highmark had not shown the rates were requested or otherwise exempt under RTKL § 708(b)(11).
On appeal, the Commonwealth Court reversed OOR, holding the Reform Act and HPCA must be construed together: § 6329’s file-and-use requirement (post-repeal of the approval requirement) effectively satisfies the “requested by the Department” language in § 309(c), so the rate information is statutorily confidential; the court declined to address RTKL § 708(b)(11).

Issues

Issue	Plaintiff's Argument (Highmark)	Defendant's Argument (Requester / OOR)	Held
Whether insurance statutes exempt the rates from RTKL disclosure	§ 6329 requires filing with the Department; together with § 309(c) the rates are confidential even though formal approval was repealed	§ 309(c) protects only rates explicitly requested by the Department; repeal of approval means no filing/request required	Court held statutes read in pari materia: § 6329’s file-and-use practice satisfies “requested,” so § 309(c) makes rates confidential; reversal of OOR
Whether OOR violated Highmark’s due process by not holding a hearing	Highmark: needed a hearing and opportunity to supplement the record; seeks to add evidence on appeal	OOR/Requester: Highmark had notice, submitted affidavits and briefs, did not request a hearing, and had opportunity to present evidence	Court held no due process violation; Highmark had notice and opportunity; denied supplementation
Whether the submissions qualify as an agency "record" under RTKL when provided by a third party	Highmark: submission was required by statute and thus is an agency record	Requester/OOR: repeal of approval renders submission voluntary, so RTKL may not apply	Court held that because HPCA required filing (file-and-use), submissions are agency records; OOR erred in not analyzing this point and disclosure was improper
Whether RTKL § 708(b)(11) confidential/proprietary exception applies	Highmark: alternatively protected as confidential proprietary / trade secret under § 708(b)(11)	Requester/OOR: Highmark’s affidavit failed to show substantial competitive harm; insufficient evidence	Court did not decide § 708(b)(11) because statutory exemption resolved the case (remanded not required)

Key Cases Cited

Dep’t of Labor & Indus. v. Heltzel, 90 A.3d 823 (Pa. Cmwlth. 2014) (RTKL public-record presumption and scope of review)
Bagwell v. Dep’t of Educ., 131 A.3d 638 (Pa. Cmwlth. 2016) (third-party participation and burden to prove exemptions)
Global Tel*Link Corp. v. Wright, 147 A.3d 978 (Pa. Cmwlth. 2016) (confidential proprietary financial submissions under RTKL)
Dep’t of Corr. v. Maulsby, 121 A.3d 585 (Pa. Cmwlth. 2015) (due process and third-party protection of proprietary information)
Allegheny Cnty. Dep’t of Admin. Servs. v. Parsons, 61 A.3d 336 (Pa. Cmwlth. 2013) (third-party contractors bearing agency burdens)
Winslow-Quattlebaum v. Md. Ins. Grp., 752 A.2d 878 (Pa. 2000) (deference to administrative agency interpretations)
Office of the Governor v. Bari, 20 A.3d 634 (Pa. Cmwlth. 2011) (remand for hearing when third party must prove RTKL exception)
Pa. State Police v. Grove, 119 A.3d 1102 (Pa. Cmwlth. 2015) (when to supplement record on appeal)