After more than a decade, a judge has approved a historic $ 2.8 billion class action conducting involving Blue Cross Blue Shield – but for some providers this is not almost enough.
The settlement was to resolve a trial filed in 2012, when providers and hospitals claimed that Blue Cross and its affiliated plans underpaid them. Providers claimed that Blue Cross Vioated Antitrust -love by dividing the United States into “service areas” and agreed not to compose in these areas. They also argued that the insurance company fixed awards for its services.
In other words, the plaintiffs claimed that Blue Cross defeated reimbursements by colliding across different states so as not to pay more than a particular ament to services, said Guillermo Beades, partner in the Frier Levitt’s Health Committee Department.
The $ 2.8 billion settlement will be divided between approx. 3 million class members. It is the big solution for an antitrust case about healthcare.
The insurance company said in a stage to Medcity News that it is “satisfied with the court’s order that associated the settlement, we managed to resolve the requirements in this case.”
While Blue Cross Blue Shield is satisfied with the settlement, many providers are not. About 6,500 providers have chosen the settlement. Dozens have also filed their own lawsuits against the insurance company, included a large health system such as Providence, Commonspirit Health, Wellspan and Good Aid Mercy Health.
A Providence spokesperson told Medcity News that it decided to opt out of the settlement because it reflects the extent of anti -competitive damage the system experienced by Blue Cross.
“We are pursuing separate individual requirements because our estimated injuries are many, many times higher that were offered during class running, and we want all Blues’ anti -competitive and harmful practice,” the spokesperson who rejected legs.
Medcity News reached out to several other health systems that EITH refused to comment or did not respond.
The settlement
The $ 2.8 billion settlement was approved by Chief Us District Judge R. David Proctor in Alabama. In addition to the payment to members of the class case, the settlement is also Insjuire -laying down to tackle provider problems that are “the core of this trial,” the judge’s decision said.
For example, it requires changes in the Bluecard system that allows members of a blue cross plan to receive healthcare when traveling or living in another blue cross plan area. Providers must submit claims through the Bluecard system when dealing with members of another blue cross plan.
“For decades, providers have complained that positive positive, Bluecard is a non-transparent program that additional costs, ineffective and frustration,” the judge said. “The insulting relief of the settlement will signal Improvide’s experience with the Bluecard system, bring more transparency and efficiency and lead to blue power plan.”
Some of the changes in the Bluecard program include creating a cloud-based system that provides better access to membership benefits and verification information about verification and preAutorization requirements. It also requires that each blue plan must pay clean (which means without error), fully insured claims within 30 days and appoint a dedicated Bluecard director to supervise program operations.
In addition, providers will have more options for entering into value-based contracts with Blue Cross plans, the decision-making state.
In order to ensure compliance, a monitoring committee also will also include Settlement Agements for five years. The committee will review new rules proposed by Blue Cross and solve disputes in connection with the conditions of the settlement.
Why providers opt out
We face value, a settlement of $ 2.8 billion may sound like a lot of money.
But for health systems dealing with hundreds of billions of dollars in annual revenue, “it is a decrease in the bucket,” according to Pearls from Frier Levitt.
“First of all, you have to pay legal fees out of it,” he said. “And then on top of that you have an equal share. It’s not pro rata, it’s just across the 3 million participants. So if you choose, you don’t get that much money. And if you are a large group that has millions of dollars requirements that were underpaid, it won’t work to your advantage.”
Pearls added that there is also dissatisfaction with the non-monetary conditions for the settlement. Some providers feel that these reforms are going long enough to change the structure that enabled the competitive behavior in the first place.
Ultimately, providers want more transparency, pearls say.
“They want to know that there is enough control and balance in place for this to not happen again if you look at history’s trial against the big system – United Healthcare, Horizon – like every fifth to 10 years, you will see one of them. Billion dollars like here,” he said. “And that doesn’t stop them. They’ll return to do what they did five to eight years later.
Providence, meanwhile, wants reasonable compensation for Blue Cross’s wrongdoing, including “Underpayments and Limitations that have influence Providence’s ability to provide care effectively and competitively and continue to provide critical services to underrated societies,” the spokesman said.
The health system wants to keep the insurance liable and receive a decision that “reflects the true expression of the damage that our organization and the communities we earn have suffered,” the spokesman added.
In the complaint, which was filed by several health systems in March, the plaintiffs urged to permanently prohibit blues plans from nurturing agreements that determine prices or injuries competition. They also want to be astonished damage in “the form of three times the damage of the damage suffered by the plaintiffs.”
Photo: Valerii Evlakhov, Getty Images