U.S. insurer Blue Cross Blue Shield will pay $2.8 billion to settle an antitrust class action lawsuit that claims hospital systems, doctors and other health care providers were not reimbursed. They agreed, the plaintiffs said in a recent filing in Alabama federal court.
The settlement is the largest ever in a medical antitrust case, they added.
Blue Cross Blue Shield denied the allegations in a statement, but said it agreed to a settlement and made operational changes to “put years of litigation behind us.”
The providers' lead attorneys, Joe Whatley and Edith Karas, said in a statement that the proposed settlement would “transform” the BlueCard program under which providers submit claims.
The agreement is subject to approval by U.S. District Judge R. David Proctor.
Health care providers first filed suit in 2012, alleging that Blue Cross and its affiliates had divided the country into exclusive regions that did not compete with each other. The lawsuit said a nationwide conspiracy increased premiums and decreased reimbursements.
Under the proposed settlement, Blue Cross will create a system-wide information platform to facilitate member benefits, eligibility verification and claims tracking, which lawyers say will improve transparency, efficiency and accountability. states.
The settlement will give providers more opportunities to contract with Blue Cross.
Blue Cross plans to spend hundreds of millions of dollars to realize the non-monetary portion of the settlement, according to the filing.
The settlement covers U.S. health care providers, including hospitals and some physicians, and covers Blue Plan patients from July 2008 to October 2024.
Lawyers said they will seek up to $700 million in legal fees from Blue Cross.
In 2020, Blue Cross agreed to pay $2.7 billion to resolve related antitrust claims from commercial and independent contractors. The U.S. Supreme Court upheld the agreement in June.
Meanwhile, Blue Cross Blue Shield of Louisiana was sued in state civil court in September after its insurer underpaid claims for a surgical center in New Orleans that often treats cancer patients. was ordered by a jury to pay more than $400 million. Blue Cross has vowed to appeal the ruling in an effort to mitigate, if not eliminate it entirely.
Parent staff contributed reports
