U.S. insurer Blue Cross Blue Defend agreed to pay $2.8 billion to settle class-action antitrust lawsuits filed by hospital systems, doctors and other health providers who alleged they were underpaid for reimbursements, the plaintiffs said in a filing recently filed with a Alabama federal court.
The settlement is the largest ever reached in an antitrust case in the healthcare sector, they added.
Blue Cross Blue Defend denied the allegations in a statement, but said it accepted the settlement and made operational changes to “put years of litigation behind us.”
The providers' lead attorneys, Joe Whatley and Edith Kallas, said in a statement that the proposed settlement would “transform” the BlueCard program through which providers file claims.
The settlement is subject to approval by U.S. District Judge R. David Proctor.
Health care providers first sued in 2012, alleging that 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 reduced reimbursements.
Under the agreement, Blue Cross will create a system-wide information platform that will facilitate member benefits, eligibility verification and claims tracking that attorneys say would lead to greater transparency, efficiency and accountability.
The agreement will also provide providers with more contracting opportunities with Blue Cross.
Blue Cross will spend hundreds of millions of dollars to implement the non-monetary part of the agreement, according to the document.
The agreement covers U.S. health care providers, including hospitals and some doctors, with Blue plan patients between July 2008 and October 2024.
The lawyers said they would seek up to $700 million in legal fees from Blue Cross.
Blue Cross agreed in 2020 to pay $2.7 billion to resolve related antitrust claims from commercial and individual subscribers. The U.S. Supreme Court upheld that agreement in June.
Meanwhile, in September, a state civil court jury ordered Blue Cross Blue Defend of Louisiana to pay more than $400 million after it was found that the insurer had paid fewer claims to a surgery center in New Orleans than it often did. works with cancer patients. Blue Cross has vowed to appeal the verdict in a bid to reduce it, if not eliminate it entirely.
Guardian staff contributed reporting