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Blue Cross Blue Shield Settles Antitrust Claims for $2.8 Billion

BCBS Association

Photo: Getty Images

Blue Cross Blue Shield (BCBS) has agreed to a $2.8 billion settlement to resolve antitrust allegations from a group of healthcare providers. The providers claimed that the insurers colluded to prevent competition and lower reimbursements. The settlement, which is pending final approval in an Alabama federal court, would conclude a decade-long legal battle that began in 2012.

The providers alleged that the Blue Cross Blue Shield Association (BCBSA) and 33 of its affiliates worked together to divide geographic regions to avoid competition. They argued that this collusion led to decreased reimbursements and increased insurance costs.

In a statement to Fierce Healthcare, the BCBSA denied the allegations but agreed to make operational changes and a monetary payment to the provider class involved in the case to put years of litigation behind them.

The settlement is applicable to any provider who treated a BCBS member from July 24, 2008, to October 4, 2024. As part of the settlement, $100 million will be set aside for notification and administration purposes.

In addition to the financial settlement, BCBS plans have agreed to make changes to the BlueCard program, a provider-facing platform used to track claims, make prior authorization requests, and submit questions to the health plan. As part of the settlement, BlueCard will move to a cloud-based system, and Blues plans have agreed to make payments promptly and with interest should payments fall outside of the set window.

This settlement follows a similar agreement in 2020 to resolve a class-action suit from consumers, who also alleged that Blues plans worked together to avoid competing against one another. The Supreme Court declined to hear a challenge to that $2.7 billion settlement over the summer.


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