After more than a decade of litigation, the national Blue Cross Blue Shield Association (BCBSA) agreed to a proposed class action settlement that would distribute $2.8 billion to impacted hospitals and providers and require substantial changes in the way the plans conduct business. The BSBSA includes among its Washington affiliates Premera Blue Cross and Regence Blue Shield and many, if not most Washington hospitals will be eligible for recovery either as a member of the class or, if they opt out of the class and pursue their own settlement. WSHA will provide additional information on options to hospitals once the proposed settlement receives preliminary approval by the court.
According to the settlement document, any provider who treated a BCBS member from July 24, 2008 to Oct. 4, 2024 is eligible for a portion of the settlement. The amount for a particular hospital or provider group will depend on the ultimate size of the class and the distribution methodology. Some hospitals and providers may opt out of the class settlement and pursue separate settlement if they believe they can successfully demonstrate financial harm. More information will be available once the settlement is approved by the court and the allocation details are known.
Besides the monetary settlement, the settlement requires the BCBSA to make significant changes to its rules to allow greater competition between plans and requires greater infrastructure and accountability for payment for services for enrollees of out of area plans contracted through the BlueCard system. The BlueCard changes include greater accountability for including prior authorization and timely payment of claims. Though the monetary settlement is significant, these operational changes may be of greater impact to hospitals and providers. WSHA will provide additional information as it becomes available. (Andrew Busz)
