What Physicians Need to Know about BCBS Settlement
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A $2.8 billion settlement has been reached in a multi-district litigation filed against Blue Cross Blue Shield Association (BCBSA) and its affiliates, resolving an over decade-long antitrust class action lawsuit. This settlement, one of the largest in healthcare antitrust history, addresses claims that BCBSA and its member plans violated antitrust laws by dividing the U.S. into exclusive service areas, limiting competition, and underpaying healthcare providers for reimbursements. Physicians may be eligible to claim a portion of this settlement and are encouraged to follow the guidance below.
The lawsuit, In re: Blue Cross Blue Shield Antitrust Litigation (MDL No. 2406), filed in 2012 in the U.S. District Court for the Northern District of Alabama, alleged that BCBSA and its affiliates engaged in anticompetitive practices. Hospitals, physicians, and other healthcare professionals claimed that the BCBSA’s BlueCard program and exclusive service area agreements suppressed competition, increased insurance costs, and reduced reimbursement rates. The settlement, announced on October 14, 2024, and granted preliminary approval on December 4, 2024, by Chief U.S. District Judge R. David Proctor, includes a $2.8 billion fund and significant operational changes to BCBSA’s operations.
Practitioners who are eligible to receive payments include physicians who provided healthcare services, equipment, or supplies to patients insured by a Blue Cross Blue Shield plan (commercial plans only, excluding Medicare, Medicaid, or Federal Employee Health Benefits Program plans) between July 24, 2008, and October 4, 2024. Certain other practitioners are excluded from the settlement class, including: (i) practitioners owned or employed by BCBS plans; (ii) practitioners who previously released claims against BCBS in earlier settlements, such as Love v. Blue Cross and Blue Shield Association); (iii) and practitioners who exclusively offer prescription drugs, durable medical equipment, medical devices, independent clinical lab services or standalone dental/vision insurance services.
Eligible physicians can file a claim to receive a portion of the $2.8 billion settlement fund. After attorney fees (up to $700 million), approximately 92% of the fund is allocated to hospitals and facilities, with 8% ($160 million) reserved for medical professionals, including physicians and medical groups/organizations. The respective payout amount depends on:
- Total charges billed to BCBS patients from 2008 to 2024 (higher billings yield more “points”, from 1 point for under $250,000 to 5 points for over $1 million);
- Geographic adjustment based on a “harm coefficient” reflecting BCBS’s impact in your area (multiplier from 1 to 5.3); and
- Number of claims filed by other practitioners, as funds are distributed proportionally.
Individual physicians and groups could recover significant sums, with some estimates suggesting millions for larger entities. By participating in the settlement, physicians should know that they release BCBSA from further antitrust claims related to the lawsuit’s allegations. However, claims unrelated to antitrust issues (e.g., contract disputes) are likely unaffected.
To ensure you benefit from this settlement, consider the following steps:
- File a Claim by July 29, 2025:
- Visit the official settlement website at www.bcbsprovidersettlement.com to submit a claim online (recommended) or by mail;
- Use the Professional Claim Form for individual physicians or medical groups, or the Facilities Claim Form for hospitals and facilities. Some organizations may need both to capture professional and facility fees;
No supporting documentation is required initially, but the Settlement Administrator may request it later. Provide your National Provider Identifier (NPI) or Tax Identification Number (TIN) for the administrator to calculate your “Allowed Amounts” or submit your own billing data.
–David Vozza, Esq., MSSNY Legal Counsel
