Alyssa Lane
Blue Cross Blue Shield (BCBS) is a health insurance company that provides a range of healthcare coverage solutions for individuals and families, including those who live, work, and travel internationally. In the event of an overpayment or error, Blue Shield may request a refund and issue a return check. Additionally, BCBS has been involved in several lawsuits and settlements, resulting in the distribution of settlement checks to eligible claimants. These checks are the result of class-action antitrust lawsuits alleging violations of competition law and agreements between BCBS health insurance plans to limit competition.
| Characteristics | Values |
|---|---|
| Reason for refund | Overpayment |
| Who to contact | Blue Cross and Blue Shield of Illinois |
| Time taken for refund | 30 working days |
| Mode of refund | Refund checks |
| Address for refund checks | Blue Shield of California Attn: Cash Receiving P.O. Box 241012 Lodi, CA 95241 |
| Mode of communication | Written or telephone |
| Time period for subscribers | February 2008 to October 2020 |
| Settlement fund | $2.67 billion |
| Number of claimants | 6 million |
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What You'll Learn
Blue Cross Blue Shield lawsuit settlement checks
The Blue Cross Blue Shield (BCBS) lawsuit settlement arose from a class-action antitrust lawsuit called In re: Blue Cross Blue Shield Antitrust Litigation MDL 2406. The settlement was reached on October 16, 2020, on behalf of individuals and companies that purchased or received health insurance provided or administered by a Blue Cross Blue Shield company.
The plaintiffs alleged that BCBS violated antitrust laws by illegally dividing the United States into "Service Areas" and agreeing not to compete in those areas. They also claimed that the BCBS companies fixed prices for the services provided. The Settling Defendants, however, denied all allegations of wrongdoing, asserting that their conduct resulted in lower healthcare costs and greater access to care for their customers.
To resolve the claims, BCBS agreed to a substantial settlement fund, reported as $2.67 billion and $2.8 billion in different sources, to avoid the risk and cost of further litigation. The Court certified two Settlement Classes in this case: a Damages Class and an Injunctive Relief Class. To receive a payment, individuals must have filed a claim by November 5, 2021, although the exact dates for sending payments have not been determined yet.
Psychologists who anticipate filing or joining future lawsuits against Blue Cross Blue Shield may consider opting out by the specified deadline. The main type of lawsuit psychologists might bring against BCBS is for not being paid under their provider contracts, which appears to be outside the settlement category. However, there is still a risk that BCBS companies may try to apply the release language more broadly to prevent future lawsuits by psychologists.
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Refund requests and overpayments
Providers have a specific timeframe to respond to refund requests and return any overpayments to avoid further action. For example, Blue Shield of California requires providers to appeal a refund request within 30 working days; otherwise, they will pursue the refund and may offset the account or assign it for recovery. Similarly, Blue Cross and Blue Shield of Illinois (BCBSIL) will recover overpayments by offsetting current claims payments if they do not receive a response or the refunded amount within 30 days of the follow-up letter.
To facilitate the refund process, Blue Cross and Blue Shield offer an Electronic Refund Management (eRM) tool, which allows providers to submit refunds online in real-time. This tool provides electronic notification of identified overpayments, enabling providers to view, search, inquire, dispute, and appeal requests online. Additionally, the eRM includes a Claim Inquiry Resolution (CIR) function, assisting providers in submitting inquiries related to specific types of claims, such as High-Dollar and Pre-Pay Review requests.
If a provider believes an overpayment occurred due to Blue Shield paying the claim as the primary insurer in error, they should notify the appropriate service center. They must send a notice of overpayment along with a copy of the Explanation of Benefits (EOB) from the primary carrier. This process ensures that any discrepancies or errors in payment are addressed and rectified promptly.
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Class action antitrust lawsuit
A class-action antitrust lawsuit, In re: Blue Cross Blue Shield Antitrust Litigation, was filed against Blue Cross Blue Shield (BCBS) by health providers who alleged they were underpaid for reimbursements. The lawsuit also addresses provider plaintiffs' claim that BCBS violated antitrust laws by illegally dividing the United States into "Service Areas" and agreeing not to compete in those areas. The plaintiffs also claim that BCBS fixed prices for services provided.
The lawsuit was first filed in 2012 when providers filed the initial complaint in Conway v. Blue Cross & Blue Shield of Alabama, arguing that the insurer avoided competition through its use of exclusive service areas, thus increasing insurance costs and decreasing reimbursements.
The court certified two settlement classes in this case: a Damages Class and an Injunctive Relief Class. The settlement will establish a $2.67 billion settlement fund, and BCBS will also agree to make changes to the way they do business, including increasing opportunities for competition in the market for health insurance.
To receive a payment, individuals must have filed a claim by November 5, 2021. This deadline may be changed, so it is recommended to check the official platform for updates. The official platform for settlement class members is where claims for a share of the Net Settlement Fund can be submitted, and up-to-date information about the Settlement Program can be found.
The settlement agreement is said to significantly improve how providers will be able to deal with BCBS, bringing more transparency, efficiency, and Blue Plan accountability.
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Changes to business practices
Blue Cross Blue Shield (BCBS) is a health insurance provider that offers a range of plans, including Qualified Health Plans (QHPs), PPO plans, and Individual and Family Plans. They also provide international coverage through Blue Cross Blue Shield Global. BCBS has been involved in several settlements and lawsuits, which have resulted in changes to their business practices.
One significant change to their business practices arose from a class-action lawsuit alleging that over 35 BCBS health insurance plans violated antitrust laws by agreeing not to compete with one another. This resulted in a $2.67 billion settlement fund, with approximately $1.9 billion being distributed across roughly 6 million claimants. As part of this settlement, BCBS agreed to make changes to their business practices to increase competition in the market for health insurance.
Another change in business practices for BCBS relates to their claims payment policy. When a BCBS member receives healthcare services from a participating provider, the provider typically submits a claim to BCBS. However, when services are received from a non-participating provider, the member or their provider must obtain prior authorization, or else Blue Shield may deny payment, making the member responsible for all billed charges. This is a notable difference in how BCBS handles claims and payments, depending on whether the provider is within their network.
In addition, BCBS has implemented a process to manage refund requests when an overpayment is identified. They send a refund request to the provider (payee), explaining the reason and including a remittance form and return envelope. If no response is received within 30 days, BCBS will recover the overpayment by offsetting current claims payments. This process ensures accurate and timely refunds while maintaining transparency through detailed documentation.
Furthermore, BCBS has made changes to their business practices regarding the processing of claims. Once a claim is received, Blue Shield or the Benefit Administrator will process it within 30 business days if all the required information is present. If any information is missing, the member or provider will be notified and asked to submit the missing details. After the claim is processed, the member may receive an Explanation of Benefits (EOB), which outlines essential information such as the provider, date, and description of each service, as well as patient responsibility and deductible status.
In summary, Blue Cross Blue Shield has implemented several changes to their business practices, including resolving lawsuits, modifying claims payment policies, introducing refund management processes, and enhancing claims processing procedures. These changes aim to increase competition, improve efficiency, and ensure accurate and transparent financial transactions.
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Eligibility for receiving settlement checks
The Blue Cross Blue Shield (BCBS) settlement is the result of a class-action antitrust lawsuit called "In re: Blue Cross Blue Shield Antitrust Litigation MDL 2406". The settlement was reached on October 16, 2020, on behalf of individuals and companies that purchased or received health insurance provided or administered by a Blue Cross Blue Shield company. The settlement established a $2.67 billion fund, with payments to be made to around 6 million people.
To be eligible to receive a payment from the settlement fund, individuals must have been enrolled in certain Blue Cross Blue Shield health insurance or administrative services plans between February 2008 and October 2020. This includes both fully insured and self-funded plans. The specific dates for the settlement class period vary slightly depending on the type of account. For individuals and insured groups, the settlement class period is from February 7, 2008, through October 16, 2020. For self-funded accounts, the settlement class period is from September 1, 2015, through October 16, 2020.
It is important to note that not all individuals associated with these plans are eligible for payment. Dependents, beneficiaries (including minors), and non-employees are specifically excluded from receiving direct payments. However, they will still benefit from certain aspects of the settlement, such as the requirement for settling defendants to change certain practices that were alleged to be anticompetitive.
To receive a payment, eligible individuals must have filed a claim by November 5, 2021. The amount of the payment will depend on several factors, including the number of valid claims filed, the premiums paid to the defendants during the class periods, and whether the insurance was fully insured or self-funded. If the total payment for a claimant is equal to or less than $5, they will not receive a check.
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Frequently asked questions
The BCBS settlement is the result of a class-action antitrust lawsuit filed against more than 35 BCBS health insurance plans. The lawsuit alleged that the defendants violated antitrust laws by agreeing not to compete with one another, thereby limiting competition in the health insurance market.
Subscribers who were covered by certain BCBS health insurance or administrative services plans between February 2008 and October 2020 are potential class members. To receive a payment, individuals must have filed a claim by November 5, 2021.
The total settlement fund is $2.67 billion, and about six million people filed claims. As a result, each claimant can expect to receive approximately $333 per claim, after deducting attorney's fees and administrative costs.
Notices of payments to claimants are being sent out via email on a rolling basis. However, there is no specific date for when the payments will be sent out. The website states that payments will not be sent until all claims have been reviewed and disputes resolved.
