Nearly 6,500 providers have opted out of a $2.8 billion antitrust settlement agreement with the Blue Cross Blue Shield Association, including hospitals owned by some of the largest health systems in the U.S.
In October, the Blue Cross Blue Shield Association, along with the 33 independent BCBS companies, agreed to pay $2.8 billion to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry. In addition to the cash settlement, BCBS plans must implement significant operational changes across 16 categories. These changes include how BCBS processes claims, communicates, contracts with, and makes payments to providers.
Health systems, physicians and other providers initially filed the lawsuit in 2012, accusing BCBS companies of conspiring to divide markets to avoid competing with one another, which allegedly drove up costs and reduced reimbursements.
In total, 6,480 providers have opted-out of the settlement, according to an Aug. 7 court filing. Facilities owned by Rochester, Minn.-based Mayo Clinic, Renton, Wash.-based Providence, Ann Arbor-based University of Michigan Health and Altamonte Springs, Fla.-based AdventHealth are among those who opted out.
In March, dozens of health systems and other provider groups filed new antitrust lawsuits against the Blue Cross Blue Shield Association and its 33 independent entities, alleging anticompetitive practices that led to suppressed payments to providers.
Those lawsuits challenge the adequacy of the 2024 settlement, with hospitals arguing that BCBS’s anti-competitive practices are still happening and continue to harm providers financially. The plaintiffs, which include CommonSpirit, Bon Secours Mercy Health, Temple University Health System, Penn Medicine, Geisinger Health, WellSpan Health, MedStar Health, and Northern Light Health, are seeking treble damages under federal antitrust law, meaning the court could award triple the amount of actual damages awarded to plaintiffs in the prior $2.8 billion settlement. The hospitals are also seeking injunctive relief to permanently ban BCBS companies from continuing their alleged collusive practice.
See the full opt-out list here.
