MINNEAPOLIS, MN/USA - MARCH 19, 2017: Blue Cross Blue Shield exterior and logo. Blue Cross Blue Shield Association (BCBSA) is a federation of health insurance organizations and companies. Credit: wolterke/Adobe Stock;
More than 6,400 providers chose to opt out of a $2.8 billion antitrust settlement with the Blue Cross Blue Shield Association by the July 29 deadline. They include hospitals owned by some of the nation’s most prominent health systems, such as the Mayo Clinic, University of Michigan Health and AdventHealth.
A lawsuit filed in 2012 accused BCBS companies of driving up costs and reducing reimbursements by conspiring to reduce competition by dividing markets among themselves. Last October, the association and 33 independent BCBS companies agreed to settle the claims for $2.8 billion. The settlement includes operational changes across in how BCBS processes claims, communicates, contracts with and makes payments to providers. Any provider who treated a BCBS member from July 24, 2008, to Oct. 4, 2024, was eligible for the settlement if they agreed to join.
Although BCBS denied the allegations, it agreed to make changes to its BlueCard program, which is used to track claims and make prior authorization requests from the provider to health plans. "To reach a settlement and put years of litigation behind us, we have agreed to make some operational changes and a monetary payment to the provider class involved in the case," a company spokesperson said at the time.
In March, several provider groups and health systems filed new antitrust lawsuits against the association and its 33 independent entities, alleging anticompetitive practices that resulted in reduced payments to providers. Hospitals argued that BCBS is continuing anticompetitive practices that cause financial harm to providers. The plaintiffs seek a tripling of the settlement amount, as well as injunctive relief to permanently ban BCBS companies from continuing their alleged collusion.
In yet another legal action, the nonprofit health system Texas Health Resources in late July sued the association and its entities for entering into agreements to limit reimbursements to providers since 2008. The plaintiffs allege horizontal market allocation and price-fixing by geographically restricting how many affiliated plans operate in each region. Each plan benefits from a quid pro quo and “artificially reduced prices” paid to providers, the lawsuit alleged. The health system is asking the judge to enjoin the defendant from using the BlueCard program and national accounts programs, as well as applying its agreements with other plans and providers.
“The BCBSA exists solely for the benefit of the Blues and to facilitate their concerted activities, and it committed numerous overt acts in substantial furtherance of defendants’ collective unlawful objectives and actions,” attorneys for Texas Health Resources said in the complaint.
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