Understanding the BCBS Lawsuit and Its Impact

The BCBS lawsuit has left many people wondering what it's all about. The lawsuit was filed against Blue Cross Blue Shield (BCBS) by several states, alleging that the company engaged in anti-competitive practices.

The lawsuit claims that BCBS has been using its market power to stifle competition and limit access to healthcare services. This is a serious issue, as it can drive up costs and reduce choices for consumers.

BCBS operates in 36 states, with a significant market share in many of them. This concentration of market power is a key concern for regulators, who want to ensure that consumers have access to affordable and quality healthcare.

The lawsuit seeks to address these concerns by requiring BCBS to divest some of its assets and allow for more competition in the market.

The BCBS lawsuit was filed on January 8, 2013, and alleged antitrust violations by Blue Cross and Blue Shield. The lawsuit claimed that BCBS companies entered into agreements not to compete with each other by allocating specific geographic markets.

A class-action lawsuit was filed, and the lawsuit withstood its final legal challenge in June of this year, when the US Supreme Court denied a last legal challenge. This paved the way for a settlement agreement.

The settlement agreement includes a $2.8 billion cash payment into a settlement fund. $2 billion of this amount will go to participants in the class-action suit, while $700 million will cover legal fees and $100 million will pay other expenses.

The lawsuit alleges that BCBS's anticompetitive practices resulted in financial harm to the provider community and higher costs for subscribers. These practices included allocating markets by using exclusive service areas to fix prices paid to providers.

Here are the groups that are considered potential class members:

The settlement requires all 33 independent Blues to invest hundreds of millions of dollars in system improvements for the benefit of providers. These improvements aim to alleviate and address the resource-draining administrative burdens and inefficiencies that providers experience.

The BCBS lawsuit settlement class action is a historic $2.8 billion antitrust settlement that aims to address the resource-draining administrative burdens and inefficiencies that providers experience.

The settlement includes a substantial cash fund and requires the 33 independent Blues to invest hundreds of millions in system improvements to address administrative inefficiencies and enhance provider interactions.

A key aspect of the settlement is the requirement for the Blues to improve their communication and payment processes, making it easier for providers to get paid on time.

The settlement also establishes a compliance process to ensure that the BlueCard Program works correctly, allowing providers to contract with out-of-area patients and reducing administrative burdens.

The settlement fund is $2.8 billion, which will be distributed to eligible providers who have been impacted by the alleged anti-competitive practices.

The settlement affects medical doctors licensed after 2009 who provided in- or out-of-network services to commercial BCBS patients between July 2008 and October 2024.

Here are the details of the settlement:

The settlement period for the BCBS lawsuit covers a significant span of time, from July 24, 2008, to October 4, 2024.

Blue Cross and Blue Shield may have underpaid by as much as 5-10%, according to independent estimates.

The settlement fund will be divided, with 92% allocated to health systems and facilities due to the significant financial impact they faced.

A cloud-based platform will be created to improve the claims process, specifically for the Bluecard process.

The platform will help with verifying claims eligibility and tracking.

This settlement aims to alleviate administrative burdens and increase transparency in the process.

The "Default method" involves the plaintiff attorneys identifying allowed amounts using the provider's Tax Identification Number and National Provider Identifier Number.

The "Alternate method" requires the provider to extract data from its own claims databases.

A "regression model" will be used to estimate the impact of BCBS' conduct, and providers will receive payment based on their pro rata portion of the settlement fund.

The payment will be contingent upon the number of settlement participants.

If you're following the BCBS lawsuit, it's essential to mark your calendar with these important dates.

January 3, 2025, is the date when class notification will be complete.

To avoid being part of the class action suit, you have until March 4, 2025, to opt out.

The final fairness hearing on the settlement and the distribution of settlement funds is scheduled for July 16, 2025.

Here are the key dates to keep track of:

If you missed the opportunity to participate in the class action suit in Spring 2021, you can take note of the deadlines from a previous case.

Formal notices were sent in Spring 2021, and the deadline to opt out of the class action suit was July 28, 2021.

If you're interested in participating in the class action suit, be aware that the deadline to file was November 5, 2021.

As a class member in the BCBS lawsuit, you have two main options: participate in the settlement or opt out. If you choose to opt out, you'll be free to file your own legal action against Blue Cross and Blue Shield.

You can't opt out if you're an employee, but as an employer, you can choose to opt out, and if you're successful in any separate legal actions against BCBS, you'll be eligible for triple damages under antitrust laws.

Here are the key points to consider:

You don't need to hire a lawyer, as Co-Lead Counsel is working on your behalf, but if you choose to exclude yourself from the settlement, you'll need to hire a lawyer to pursue your own lawsuit.

As an employee, you might be wondering what your role is in the settlement and what options you have. Employers do not have an obligation to notify employees of the settlement, but both employers and employees will receive notice through a Court-approved notice program.

You can review the Court-approved Long Form Notice, these FAQs, or contact the notice and claims administrator at (888) 681-1142 if you have any questions about the settlement.

Employers do not have an obligation to provide historical premium/administrative fee data to employees, and claimants are not required to provide this information in order to make a claim.

If an employer group opts out of the settlement, employees can still receive payment. The Proposed Plan of Distribution allows for calculation of an employee's claim value independent of whether their employer opts out of the Settlement.

Here are some key points to consider:

As a provider, you have two main options to consider: participating in the settlement or opting out of it.

If you choose to participate in the settlement, you'll be eligible to receive a share of the $2.8 billion settlement.

You'll need to formally opt out within 90 days of notification, or you'll be bound by the settlement terms.

Providers who opt out and are successful in separate legal actions against Blue Cross and Blue Shield can receive triple damages under antitrust laws.

Here are your two options in a nutshell:

You might be wondering who's eligible to join the class. This includes individuals and insured group health plans that had BCBS coverage between February 8, 2008 and October 16, 2020.

Self-funded plans are also eligible, but only if they were in effect between September 1, 2015 and October 16, 2020.

You have two lawyers representing you in this case: Michael Hausfeld of Hausfeld LLP and David Boies of Boies Schiller Flexner LLP. They are working on your behalf and you don't need to hire a separate lawyer.

Their contact information is provided below:

These lawyers will no longer represent you if you choose to pursue your own lawsuit separate from this one, or if you exclude yourself from the Settlement Classes.