BCBS reaches record antitrust settlement for $2.8B

The Blue Cross Blue Shield Association, along with the 33 independent BCBS companies, have agreed to pay $2.8 billion to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry.

In addition to the cash settlement, the plaintiffs stated in an Oct. 14 filing in Alabama federal court that BCBS plans must implement significant operational changes across 16 categories. These changes include how BCBS processes claims, communicates, contracts with, and makes payments to providers.

The new operational requirements are expected to alleviate administrative burdens and inefficiencies experienced by providers, according to the plaintiffs' counsel. The settlement applies to providers who treated BCBS members between July 2008 and October 2024.

The tentative agreement still requires approval from U.S. District Judge R. David Proctor. The BCBS Association denies the allegations made in the lawsuit.

"This settlement ends a long-running legal challenge to the Blue Cross Blue Shield Association license agreements and related rules," a BCBSA spokesperson told Becker's. "However, to reach a settlement and put years of litigation behind us, we have agreed to make certain operational changes and provide a monetary payment to the provider class involved in the case."

Health systems, physicians, and other providers initially filed the lawsuit in 2012, accusing BCBS companies of conspiring to divide markets to avoid competing with one another, which allegedly drove up costs and reduced reimbursements.

“Over the past 12 years, we have dedicated an extraordinary amount of time, tireless effort, and resources to achieve this historic outcome for providers,” Co-Lead Counsel Edith Kallas said. “Many important issues for providers are finally being addressed. We’re pleased to have achieved relief that will create a better system for healthcare providers, supporting the organizations and individuals we rely on to take care of us and our families every day.”

BCBS will be monitored by a special committee for five years following the court’s final settlement approval. A group consisting of representatives from health systems, hospitals, physicians, ancillary providers, and medical and hospital associations provided input throughout the settlement process.

"Our members and healthcare provider partners can rest assured that Blue Cross and Blue Shield companies remain strong and ready to deliver exceptional services. We are committed to providing access to affordable, high-quality care and improving the health of the communities we serve, just as we have for 90 years," the BCBSA spokesperson added.

This settlement follows another antitrust lawsuit from BCBS customers, first filed in 2012. In October 2020, BCBS companies and the association reached a $2.7 billion settlement, in which BCBS admitted no wrongdoing. That settlement required BCBS companies to eliminate an association rule that mandated two-thirds of national net revenues from health plans and related services come from Blue-branded products. Another rule struck down by the settlement required large employers to work with the Blue insurer located where the employer was headquartered, preventing BCBS companies from competing for large contracts.

The U.S. Supreme Court upheld the customer settlement in June 2024.

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