US insurer Blue Cross Blue Shield has agreed to pay $2.8bn to resolve antitrust class action claims by hospital systems, physicians and other health providers alleging they were underpaid for reimbursements, the plaintiffs said in an Alabama federal court filing recently.
The settlement is the largest ever for a healthcare antitrust case, they added.
Blue Cross Blue Shield denied the allegations in a statement but said it agreed to the settlement and to make operational changes to “put years of litigation behind us”.
The providers’ lead attorneys, Joe Whatley and Edith Kallas, said in a statement the proposed settlement would “transform” the BlueCard program through which providers submit claims.
The agreement is subject to approval from US district judge R David Proctor.
The health providers first sued in 2012, claiming Blue Cross and its affiliates divided the country into exclusive areas where they did not compete with each other. The lawsuit said the nationwide conspiracy increased the cost of insurance and drove down reimbursements.
Under the settlement, Blue Cross will create a system-wide information platform facilitating member benefits, eligibility verification and claims tracking that the attorneys said would lead to more transparency, efficiency and accountability.
The settlement will also give providers more contracting opportunities with Blue Cross.
Blue Cross will spend hundreds of millions of dollars implementing the non-monetary part of the settlement, the filing said.
The settlement covers US healthcare service providers, including hospitals and some doctors, with Blue plan patients between July 2008 and October 2024.
The lawyers said they would ask for up to $700m in legal fees from Blue Cross.
Blue Cross agreed in 2020 to pay $2.7bn to resolve related antitrust claims from commercial and individual subscribers. The US supreme court upheld that deal in June.
Meanwhile, in September, Louisiana’s Blue Cross Blue Shield was ordered by a state civil court jury to pay more than $400m after the insurer was found to have underpaid claims to a surgery center in New Orleans that often works with cancer patients. Blue Cross has vowed to appeal the verdict in a bid to reduce – if not entirely eliminate – it.
Guardian staff contributed reporting
