You may be eligible to receive a cash payment from the $2.8 Billion recovered in this Class Action Settlement if you are a a Provider in the U.S. who currently provide or provided healthcare services, equipment or supplies to any patient who was insured by, or was a Member of or a beneficiary of, any plan administered by any Settling Individual Blue Plan from July 24, 2008 through October 4, 2024.
July 24, 2008 through October 4, 2024
All Providers in the U.S. (other than Excluded Providers, who are not part of the Settlement Class) who currently provide or provided healthcare services, equipment or supplies to any patient who was insured by, or was a Member of or a beneficiary of, any plan administered by any Settling Individual Blue Plan during from July 24, 2008 to October 4, 2024 (“Settlement Class Period”).
Excluded from the Settlement are:
Any Provider that falls within the exclusion(s) set forth in clauses (i), (ii) or (iv) of this paragraph for only a portion of the Settlement Class Period is a Settlement Class Member that may recover in the Settlement.
*“Commercial Health Benefit Product” means any product or plan providing for the payment or administration of healthcare services (including but not limited to medical, pharmacy, dental, and vision products and services) or expenses through insurance, reimbursement, or other similar healthcare financing mechanism, for Members in the U.S. (however funded, including insured or self-funded) other than a product or plan purchased or offered by a Government Entity such as Children with Special Health Care Needs Program (CSHCN) Children’s Health Insurance Program (CHIP) Civilian Health and Medical Program of the Department of Veteran’s Affairs (CHAMPVA) Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Indian Health Service, Tribal, and Urban Indian Health Plan Medicaid Medicare Medicare Advantage (including but not limited to Medicare Advantage Prescription Drug Plans and Special Needs Plans, including but not limited to Medicare-Medicaid or Dual-Eligible Plans) Medicare Stand-Alone Prescription Drug Plans Refugee Medical Assistance Program State Maternal and Child Health Program (MCH) or TriCare.
Any Provider who was a member of any of the settlement classes in Love v. Blue Cross and Blue Shield Association, and who did not opt out, will be considered an Excluded Provider. Such Excluded Providers include medical doctors who were licensed to practice prior to March 12, 2008.
For the avoidance of doubt, dental or vision providers who exclusively provided services, equipment or supplies covered by standalone dental or vision insurance are not Settlement Class Members.
$2.576 Billion
92% of the Net Settlement Fund will be allocated to the Health Care Facilities as a “Hospital/Facility Net Settlement Fund.” The Hospital/Facility Net Settlement Fund will be distributed to Health Care Systems that submit claims on behalf of their Health Care Facilities and individual Health Care Facilities that are Authorized Claimants (i.e., Class Members who submit a valid approved claim).
$224 Million
The remaining 8% of the Net Settlement Fund will be allocated to a “Professionals Net Settlement Fund.” The Professionals Net Settlement Fund will be distributed to Medical Groups and Medical Organizations that submit claims on behalf of their Medical Professionals, as well as individual Medical Professionals that are Authorized Claimants.
“Provider” means any person or entity that provides healthcare services in the U.S., including but not limited to a physician, group practice, or facility.
The providers claimed that the Settling Defendants violated antitrust laws by illegally dividing the United States into “Service Areas” and agreed not to compete in those areas. They also claim that the Settling Defendants fixed prices for services provided.
The Court has not decided who is right or wrong. Instead, Plaintiffs and Settling Defendants have agreed to a Settlement to avoid the risk and cost of further litigation. Settling Defendants deny all allegations of wrongdoing.
Authorized Claimants must:
• Identify each National Provider Identifier (NPI) or Taxpayer Identification Number (TIN)
• Specify the time period for which it is submitting a claim for each NPI or TIN
• Allowed Amounts will be calculated separately for each NPI or TIN