After 12 years of litigation, Blue Cross and Blue Shield and providers have reached a $2.8 billion settlement in federal court in Alabama.
On Aug. 19, the District Court for the Northern District of Alabama issued the final order in the provider class action settlement.
The settlement is expected to benefit more than 1 million providers. As of April 18, 15,589 providers requested to opt out of the settlement.
The agreement includes changes to the BlueCard program; modification to the Blue Rules to enhance value-base and Contiguous Area contracting; upgrades to Blues’ technical systems; and making claims information more readily available to providers.
It also establishes a monitoring committee to oversee compliance and address any grievances, according to the settlement.
WHY THIS MATTERS
BCBS was accused of dividing up the country into geographic markets.
The settlement resolves claims that BCBS insurers violated antitrust laws by entering into an agreement not to compete with each other and to limit competition among themselves in selling health insurance, according to the BCBS settlement website.
Providers faced a deadline to opt out of the agreement. Doug Wolfe, a partner at Wolfe Pincavage in Miami, Florida, said in March that the downside of participating was ambiguity over whether the release extended to claims in the ordinary course of business.
Co-lead counsel for the Provider Class said in March that there was a specific exception for ordinary course of business claims. Attorneys Joe Whatley and Edith Kallas said at the time that the amount of money to be distributed to the class was approximately $1.9 billion. Injunctive relief, which the court called “extraordinary,” was valued at more than $17.3 billion, they said.
THE LARGER TREND
This case is separate from a $2.67 billion class action antitrust settlement related to individuals.
In 2021, millions of Blue Cross and Blue Shield beneficiaries received notices that they could be eligible for a share of a $2.7 billion antitrust. The deadline for individuals to file a claim was Nov. 5, 2021.
Email the writer: SMorse@himss.org