When Blue Cross and Blue Shield of Northern Ohio announced a selective contracting program based on competitive bidding, the greater Cleveland hospitals were shocked. This process required competitive bidding for all lines of Blue Cross business including inpatient and outpatient hospital services. A lawsuit against Blue Cross was filed by Lakewood Hospital. The program was declared illegal, but an appeal is pending that could set precedent for other Blue Cross plans that may try other forms of competitive bidding in the future.