After
more
than
a
decade,
a
judge
has
approved
a
historic
$2.8
billion
class
action
settlement
involving
Blue
Cross
Blue
Shield
—
but
for
some
providers,
this
isn’t
nearly
enough.
The
settlement
was
to
resolve
a
lawsuit
filed
in
2012,
in
which
providers
and
hospitals
claimed
that
Blue
Cross
and
its
affiliated
plans
underpaid
them.
Providers
alleged
that
Blue
Cross
violated
antitrust
laws
by
dividing
the
U.S.
into
“service
areas”
and
agreeing
not
to
compete
in
those
areas.
They
also
argued
that
the
insurer
fixed
prices
for
its
services.
In
other
words,
the
plaintiffs
alleged
that
Blue
Cross
deflated
reimbursements
by
colluding
across
different
states
to
pay
no
more
than
a
certain
amount
for
services,
said
Guillermo
Beades,
a
partner
in
Frier
Levitt’s
Healthcare
Litigation
Department.
The
$2.8
billion
settlement
will
be
split
between
about
3
million
class
action
members.
It
is
the
largest
settlement
for
a
healthcare
antitrust
case.
The
insurer
said
in
a
statement
to
MedCity
News
that
it
is
“pleased
with
the
Court’s
Order
approving
the
settlement
we
reached
to
resolve
the
claims
in
this
case.”
While
Blue
Cross
Blue
Shield
is
content
with
the
settlement,
many
providers
are
not.
About
6,500
providers
have
opted
out
of
the
settlement.
Dozens
have
also
filed
their
own
lawsuits
against
the
insurer,
including
large
health
systems
like
Providence,
CommonSpirit
Health,
WellSpan
and
Bon
Secours
Mercy
Health.
A
spokesperson
for
Providence
told
MedCity
News
that
it
decided
to
opt
out
of
the
settlement
because
it
isn’t
reflective
of
the
scale
of
anticompetitive
harm
the
system
experienced
by
Blue
Cross.
“We
are
pursuing
separate
individual
claims
because
our
estimated
damages
are
many,
many
times
higher
than
what
was
offered
under
the
class
settlement
and
we
want
to
put
an
end
to
all
of
the
Blues’
anticompetitive
and
harmful
practices,”
the
spokesperson
who
declined
to
be
named
said.
MedCity
News
reached
out
to
numerous
other
health
systems,
who
either
declined
to
comment
or
did
not
respond.
The
settlement
The
$2.8
billion
settlement
was
approved
by
Chief
U.S.
District
Judge
R.
David
Proctor
in
Alabama.
In
addition
to
the
payment
to
class
action
members,
the
settlement
also
requires
injunctive
relief
to
address
provider
issues
that
have
“been
at
the
heart
of
this
litigation,”
the
judge’s
decision
stated.
For
example,
it
requires
changes
to
the
BlueCard
system,
which
allows
members
of
one
Blue
Cross
plan
to
receive
healthcare
services
when
traveling
or
living
in
another
Blue
Cross
plan
area.
Providers
have
to
submit
claims
through
the
BlueCard
system
when
they
treat
members
of
another
Blue
Cross
plan.
“For
decades,
Providers
have
complained
that,
despite
its
positives,
BlueCard
is
a
non-transparent
program
that
causes
additional
costs,
inefficiencies,
and
frustration,”
the
judge
said.
“The
Settlement
Agreement’s
injunctive
relief
will
significantly
improve
Providers’
experience
with
the
BlueCard
system,
bring
more
transparency
and
efficiency,
and
lead
to
Blue
Plan
accountability.”
Some
of
the
changes
to
the
BlueCard
program
include
creating
a
cloud-based
system
that
provides
better
access
to
member
benefits
and
eligibility
verification
information
and
preauthorization
requirements.
It
also
requires
each
Blue
plan
to
pay
clean
(meaning
without
errors),
fully
insured
claims
within
30
days
and
to
appoint
a
dedicated
BlueCard
executive
responsible
for
overseeing
program
operations.
Additionally,
providers
will
have
more
opportunities
to
enter
into
value-based
contracts
with
Blue
Cross
plans,
the
decision
stated.
To
ensure
compliance,
a
monitoring
committee
will
also
oversee
the
settlement
agreement’s
implementation
for
five
years.
The
committee
will
review
new
rules
proposed
by
Blue
Cross
and
resolve
disputes
related
to
the
settlement’s
terms.
Why
providers
are
opting
out
On
face
value,
a
$2.8
billion
settlement
may
sound
like
a
lot
of
money.
But
for
health
systems
dealing
with
hundreds
of
billions
of
dollars
in
annual
revenue,
“it’s
a
drop
in
the
bucket,”
according
to
Beades
of
Frier
Levitt.
“First
of
all,
you
have
to
pay
legal
fees
out
of
that,”
he
said.
“And
then
on
top
of
that,
you
have
an
equal
share.
It’s
not
pro
rata,
it’s
equal
across
the
3
million
participants.
So
if
you
opt
in,
you’re
not
going
to
be
getting
that
much
money.
And
if
you
are
a
large
group
who
has
millions
of
dollars
of
claims
that
were
underpaid,
it’s
not
going
to
work
to
your
benefit.”
Beades
added
that
there
is
also
dissatisfaction
with
the
non-monetary
terms
of
the
settlement.
Some
providers
don’t
feel
that
these
reforms
go
far
enough
to
change
the
structure
that
permitted
the
anti-competitive
behavior
in
the
first
place.
Ultimately,
providers
want
more
transparency,
Beades
stated.
“They
want
to
know
that
there’s
enough
checks
and
balances
in
place
for
this
not
to
happen
again
because
if
you
look
at
the
history
litigation
against
large
systems
—
UnitedHealthcare,
Horizon
—
like
every
five
to
10
years,
you’ll
see
one
of
them
get
dinged
for
hundreds
of
millions
to
a
billion
dollars
like
here,”
he
said.
“And
that
doesn’t
stop
them.
They
will
go
back
to
doing
what
they
did
five
to
eight
years
later.”
Providence,
meanwhile,
wants
fair
compensation
for
Blue
Cross’
wrongdoing,
including
“underpayments
and
restrictions
that
have
impacted
Providence’s
ability
to
deliver
care
efficiently
and
competitively
and
to
continue
to
provide
critical
services
to
underserved
communities,”
the
spokesperson
said.
The
health
system
wants
to
hold
the
insurer
accountable
and
receive
a
resolution
that
“reflects
the
true
extent
of
the
harm
our
organization
and
the
communities
we
serve
have
suffered,”
the
spokesperson
added.
In
the
complaint
filed
by
multiple
health
systems
in
March,
the
plaintiffs
called
for
permanently
prohibiting
Blues
plans
from
entering
into
agreements
that
fix
prices
or
harm
competition.
They
also
want
to
be
awarded
damages
in
the
“form
of
three
times
the
amount
of
damages
suffered
by
Plaintiffs.”
Photo:
Valerii
Evlakhov,
Getty
Images
Kerriann
