Providers are suing insurers over what they describe as systematic underpayment and unilateral policy changes that reduce reimbursement, while insurers have been turning to the courts to accuse hospitals of gaming the No Surprises Act’s arbitration process. Layered on top are antitrust cases targeting the pricing vendors and market structures that determine what gets paid.
Here are five health system vs. payer lawsuits to watch:
Jefferson Health v. Aetna
Philadelphia-based Jefferson Health sued Aetna on April 6 in the Eastern District of Pennsylvania over the insurer’s level-of-severity inpatient payment policy, which took effect Jan. 1. The Medicare Advantage policy reimburses certain approved inpatient stays lasting one to four midnights at observation-level rates unless Aetna’s severity criteria are met. Jefferson alleges the policy conflicts with federal Medicare Advantage requirements, including CMS’ two-midnight framework, and creates a payment tier not authorized by its contracts with Aetna. Jefferson filed a separate lawsuit against Independence Blue Cross on July 22, alleging five reimbursement policy changes, including two inpatient policies, have reduced or will reduce its payments by nearly $100 million.
California Hospital Association v. Anthem Blue Cross
The California Hospital Association sued Anthem Blue Cross on May 4 on behalf of its more than 400 member hospitals, challenging a policy that reduces facility reimbursement by 10% when an Anthem enrollee receives certain services from an out-of-network physician at an in-network hospital. Anthem has said the policy is intended to encourage network participation and address what it characterizes as misuse of the No Surprises Act arbitration process to obtain inflated payments. CHA alleges the policy violates California law and improperly shifts Anthem’s network responsibilities onto hospitals. Elevance Health has introduced the policy or versions of it in multiple states. Iowa enacted legislation in March banning insurers from penalizing hospitals for working with out-of-network providers, while Indiana enacted narrower legislation regulating when and how such penalties may be imposed.
Anthem Blue Cross v. 11 Prime Healthcare hospitals
Anthem sued 11 Ontario, Calif.-based Prime Healthcare hospitals Jan. 5 in the Central District of California, alleging they knowingly flooded the No Surprises Act arbitration system with more than 6,000 ineligible disputes and extracted more than $15 million in improper awards. Prime has called the suit meritless and says it does not balance bill patients. The system has also pointed the court to two recent decisions in California and Texas dismissing similar claims against billing company HaloMD, with the courts finding that insurers could not use those lawsuits to obtain review of arbitration awards beyond the limited grounds under the No Surprises Act. Both decisions have been appealed.
Provider antitrust litigation against Zelis and MultiPlan
The larger case against MultiPlan (now Claritev) involves multidistrict litigation that consolidates more than 100 complaints from health systems, providers and the AMA, alleging the vendor served as a hub for insurers to fix out-of-network rates using shared data. The case cleared a key dismissal ruling in June 2025 and keeps adding complaints, a June antitrust lawsuit from Arizona’s attorney general, and a reported DOJ criminal price-fixing investigation, even as the vendor has beaten similar suits from providers previously.
The larger case against MultiPlan, now Claritev, is multidistrict litigation consolidating more than 100 provider complaints alleging the vendor served as a hub through which insurers fixed out-of-network rates using shared information and repricing tools. A federal judge allowed key antitrust claims to proceed in June 2025, and additional providers continue to join the litigation. Arizona’s attorney general filed a separate antitrust lawsuit in June. The Capitol Forum has also reported that the Justice Department is conducting a criminal price-fixing investigation, though Claritev has said it received a 2024 grand-jury subpoena concerning health insurance and has not been told it is a target.
BCBS antitrust settlements and the opt-out litigation
A $2.67 billion subscriber settlement resolving allegations that BCBS plans divided geographic markets and limited competition began distributing payments in 2026 after surviving appellate challenges, with the underlying consolidated litigation dating to 2012. A separate $2.8 billion provider settlement, described as the largest healthcare antitrust settlement in U.S. history, received final approval in August 2025. Nearly 6,500 providers opted out, including providers affiliated with Mayo Clinic, Providence, University of Michigan Health and AdventHealth, and numerous systems have filed separate lawsuits alleging continued or unresolved anticompetitive conduct. On Feb. 25, physician staffing groups filed another federal lawsuit in California alleging market allocation, suppression of provider reimbursement and price fixing across the BCBS system.
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