A U.S. District Court in Alabama has given preliminary approval to a landmark antitrust settlement involving Blue Cross Blue Shield (BCBS), calling for the insurer to pay $2.8 billion into a settlement fund designated for settlement class members, including physicians, group practices, and health care facilities who meet certain criteria.
The Dec. 6 decision progresses the settlement toward the final fairness hearing scheduled for July 29, 2025, after over a decade of litigation and negotiations.
Physicians and physician groups who want to make a claim and meet settlement criteria can file a claim by July 29 at the website established upon the court’s preliminary approval. Whatley Kallas LLP, co-lead counsel in the case on behalf of medicine, will host webinars on how eligible entities can submit claims. The first, for health care facilities, will take place Jan. 10 at 11 am CT; other medical groups and professionals can attend a Jan. 16 session.
The settlement agreement involves all Blue Cross and Blue Shield entities, as well as the Blue Cross Blue Shield Association, and will require BCBS to “invest millions in system improvements to address widespread issues currently affecting providers,” which will “bring substantial changes to the BlueCard Program and the Blues’ operations, including accountability, streamlining claims processing, enhancing provider communications and reducing administrative burdens and inefficiencies for healthcare providers.”
Texas Medical Association President G. Ray Callas, MD, finds the outcome encouraging.
“No matter what insurance plan it is or what health plan it is, we definitely need transparency and streamlining related to claims processing and ... authorizations to make sure that physicians are being paid timely and appropriately,” he said.
The settlement was announced Oct. 14, 2024, by Whatley Kallas firm partners Joe Whatley and Edith Kallas.
“We believe it will be approved by the court, and it would be the largest health care antitrust settlement – also the largest antitrust settlement of any kind that didn't have a related government investigation,” Mr. Whatley said.
Ms. Kallas and Mr. Whatley also helped secure a settlement in the In Re Managed Care Litigation case, initiated in 2000 and joined by TMA the following year. That suit accused 10 of the nation’s major private health plans of conspiring to delay and reduce payments to clinicians and hospitals by downcoding claims and using intimidation tactics during contract negotiations, among other means. The lawsuit was brought under the Racketeer Influenced and Corrupt Organizations Act (RICO). The resulting settlement brought $2 billion in relief to physicians, new enforcement changes, and welcome reforms to insurance business practices.
Funds from that settlement also helped establish the Physicians Foundation and Physicians Advocacy Institute, two organizations that often collaborate with TMA in advocacy for medicine.
Mr. Whatley, who has worked with TMA since the late ‘90s, heralded the expected Blue Cross Blue Shield settlement as beneficial for patients as well as their physicians.
“We are obviously very proud of the result here,” Mr. Whatley said. “We've had a long history with TMA, and we're glad to benefit its members, even when we're not directly representing TMA.”
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.