MIAMI – A class action settlement involving most of the Blue Cross and Blue Shield health plans and the umbrella Blue Cross and Blue Shield Association is expected to help physicians’ offices in obtaining payment for services from health maintenance organizations.
The settlement of a class action suit with the Blues, announced last month, means that almost all operators of HMOs have agreed to implement “business practice changes” that will streamline how the companies interact with physicians.
The Blues plans involved in the most recent settlement cover about 77 million patients.
The suit was filed in 2003, said Matthew C. Katz, executive director of the Connecticut State Medical Society, one of the first physician organizations to file suit against HMO operators.
Suits from other physician groups against the Blues and other insurers have been consolidated into class action suits.
Katz said United Healthcare is the only major insurer that has declined to settle class action suits involving physician groups.
The settlement with the Blues in Love et al. v. Blue Cross Blue Shield Association involves a guaranteed cash payment of $128 million for members of the class.
In addition, the Blues plans agreed to implement medical necessity definitions, use clinical guidelines in making medical necessity determinations, establish a board for resolving billing disputes, ensure prompt payment of clean claims, establish dispute mechanisms and improve communication.