October 2024 Update
Groundbreaking $2.8 Billion BCBS Provider Settlement Brings Major Reforms and Benefits to Healthcare Providers
In what may be the largest antitrust class action settlement in healthcare history, the Blue Cross Blue Shield Association and its entities ("the Blues") have established a $2.8 billion settlement fund for providers, along with significant reforms designed to enhance the BlueCard Program and improve the overall efficiency of provider interactions.
Preliminary approval is still pending, but once finalized, the settlement will deliver significant advantages for healthcare providers, including better access to real-time patient data through a new cloud-based platform, faster claims processing, enhanced communication tools, and stronger guarantees for prompt payments related to the BlueCard Program. Additionally, a National Executive Resolution Group will be established to oversee the continuous improvement of the BlueCard Program, ensuring long-term benefits for providers.
Class Eligibility for the Proposed Settlement
The settlement class includes all healthcare providers* in the U.S. who, during the Settlement Class Period (July 24, 2008, through October 4, 2024), provided services, equipment, or supplies to patients insured by or beneficiaries of any plan administered by a Settling Individual Blue Plan. Excluded Providers are not part of the Settlement Class.
*For the purposes of this settlement, a "Provider" is defined as any person or entity that delivers healthcare services in the U.S., including but not limited to physicians, group practices, or healthcare facilities.
Excluded from the Settlement Class:
Providers owned or employed by any Settling Defendant.
Providers exclusively employed by government entities or who solely served Medicare, Medicaid, or Federal Employee Health Benefits Program members.
Providers who previously released their claims against the defendants, such as those part of the Love v. Blue Cross and Blue Shield settlement.
Providers who exclusively offer prescription drugs, durable medical equipment, medical devices, independent clinical lab services, or dental/vision services covered by standalone insurance plans.
Subscriber Settlement Update
You may recall that there was a $2.7 billion settlement for employee benefit plans with a claim filing deadline in November 2021. A key point of clarification is that this settlement covered the subscriber class (i.e. patients and employee benefit plans). This was not the anticipated settlement for the provider class (healthcare organizations).
Following the resolution of appeals, the BCBS Subscriber Settlement was finalized in June 2024, offering new benefits for large self-funded national Employers. Eligible Employers can now request bids from a second Settling Individual Blue Plan, in addition to their local plan, by contacting the Blue Cross Blue Shield Association or their local plan, or through their broker, to document their choice for this additional coverage option.
You can find more details on the Second Blue Bid and eligibility at the court-authorized settlement website: https://www.bcbssettlement.com/secondbluebid.
Background
In order to set the context for this litigation, it is helpful to know some important historical background information. Blue Cross (hospital insurance) and Blue Shield (physician/medical insurance) plans were created as non-profit prepayment insurance plans with the intention of providing affordable health care coverage for the communities each plan served. Blue Shield came first in the logging camps of the Pacific Northwest at the turn of the 20th century. Blue Cross followed in 1929.
Over time, the American Hospital Association (AHA) issued standards for the hospital prepayment plans and gave permission to hospitals to identify themselves as being covered by Blue Cross plans with the seal of the AHA superimposed upon a blue cross. A Blue Cross Commission was created in 1937 to control and approve Blue Cross plans—they promoted one plan per service area. The American Medical Association soon followed the AHA in 1946 by sponsoring the founding of the Associated Medical Plans, Inc., with its role in relation to medical-care plans analogous to that played by the Blue Cross Commission with hospital service plans. By 1947, competition from commercial insurance companies for employer-sponsored plans prompted Blue Cross and Blue Shield plans to unify, setting up agreements to ensure that members of both plans would have more comprehensive coverage nationwide.
By the early 1970s, the AHA had transferred ownership of the Blue Cross service mark to the Blue Cross Association and the Associated Medical Care Plans, Inc. had spun off into the Blue Shield Association. In 1978 these two associations consolidated their staff and then fully merged in 1982. Both the Blue Cross and Blue Shield names as well as service marks (Blue Marks) were united and given the name the “Blue Cross and Blue Shield Association” (the Association); governed by member plans.
Today, the Association is a federation of 33 separate health insurance companies (plans) that provide health insurance in the United States to more than 106 million people. The plans are the governing members of the Association, they can repeal/amend bylaws as well as implement new bylaws. Each member plan is bound by the Association rules and are autonomous in their operations. Each plan’s CEO has a fiduciary responsibility to both their individual plan and the Association.
License Agreement
Each plan has signed a License Agreement with the Association that identifies an exclusive “service area” where a member plan may use the Blue Marks. Plans are not able to develop a provider network or contract with a healthcare provider outside its service area for services to be provided under the Blue Marks. A “Map Book” is used to display defined service areas. The Map Book is a “highly sensitive” document that is not public record nor distributed to the plans.
The plans agree to not use the Blue Marks outside their service area and they can be fined by the Association for doing so. However, since its earliest days, there has been competition among the differing member plans. Today, it is rare, but there are several plans that do overlap one another.
Exclusive Service Areas
The use of Exclusive Service Areas (ESAs) by the Association has led to some antitrust violation claims in the past. In 1985, the Attorney General of Maryland sued the Association saying the use of ESAs violated federal and state antitrust laws. Even so, plan CEO’s acknowledged the benefits of the ESAs, claiming they allowed for more aggressive bargaining and guaranteed larger market share because other Blue plans stayed out of area.
Next Steps for MCAG Clients
MCAG specializes in helping healthcare providers streamline the claims process, ensuring they don’t miss out on their portion of the settlement. With a history of successfully managing settlement recoveries for thousands of providers and hospitals, MCAG makes the filing process effortless, allowing our clients to focus on their practice rather than paperwork.
How MCAG Can Help You:
Expert Settlement Filing: With our deep understanding of class action settlements, we’ll manage your claim from start to finish, ensuring every detail is taken care of.
Time and Resource Savings: We handle the time-consuming tasks of filing, so you don’t have to.
Maximized Recovery: Our experience ensures that you receive the full amount you’re eligible for, without the hassle.
Although the official claim form for the BCBS Provider Settlement is not yet available, MCAG is actively monitoring the situation. Once the forms and additional documentation are released, we’ll update you with all the necessary details and guide you through the next steps.
This settlement is a major opportunity for healthcare providers, and MCAG is here to ease the burden. With us on your side, you can rest assured that your claim is in expert hands.
Need more information? Call MCAG at 1-800-355-0466 to learn more or CLICK HERE to complete our contact form and an MCAG representative will respond shortly.
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