Update on the Blue Cross Blue Shield antitrust settlement

On December 19, 2024, APA Services provided an overview of the $2.8 billion class action settlement by the nation’s Blue Cross Blue Shield (BCBS) companies.

Now we are turning our focus to the upcoming March 4 deadline for opting out of the settlement for those psychologists who are in the class (see Section B) and who believe the value of future lawsuits they may have or join against BCBS companies may outweigh the settlement recovery in this case and other policy benefits from the settlement (referred to as “injunctive relief” in the settlement).

Unfortunately, the key variables for making that decision remain uncertain. Those variables include the likely amount and timing of payment from this settlement (described in Section A and in the “What may you get?” section of the overview), the scope of future lawsuits that might be blocked if you don’t opt out (discussed in Section C), and possible recoveries in future lawsuits. We note that suing major insurers like BCBS companies—while very important—is generally a slow and uncertain process, and one that is very expensive unless done as a class action or on a contingency basis.

If you are in the settlement class but don’t intend to file a claim in this settlement, you only need to weigh whether the policy benefits of the settlement outweigh the potential of future lawsuits. Unless you affirmatively opt out, you are considered to be part of the settlement class and release, even if you do not file a claim in this settlement.

In the case, In re: Blue Cross Blue Shield Antitrust Litigation (MDL No. 2406)opens in new window, 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 alleged that the BCBS companies fixed prices for services provided. To resolve these claims, BCBS agreed to a $2.8 billion settlement fund to avoid the risk and cost of further litigation. But only 8% of the net settlement fund ($160 million after fees and expenses) is allocated to Professionals, a category that includes medical and health care groups, medical organizations, and then individual medical and health care professionals, like psychologists, who submit valid claims. (Most of the fund will go to hospitals and large health care facilities.) Updated information indicates that, given the very large number of eligible providers nationally and the limited funds available, depending on the number of claims submitted, some individual settlement recoveries may be less than $1,000. Also, objections to the settlement may delay the finalization of the settlement and the issuance of settlement payments for several years.

BCBS also agreed to certain policy changes (injunctive relief) for a five-year period, starting after all claims are paid. They include streamlined claims processing, improved prior authorization processes, more timely communication (including setting up real time messaging to resolve issues), transparent decision making, and increased accountability. These are described at pp. 6–9 of the Settlement Noticeopens in new window¹ and pp. 30–50 of the Settlement Agreement, which is available on the Blue Cross Blue Shield Provider Settlement websiteopens in new window. To access the Settlement Agreement, visit the homepage and scroll down to the “Important Documents” section, then click on “Settlement Agreement.”

The settlement class includes all U.S. providers who currently provide or provided health care services to any patient who was insured by any plan administered by BCBS companies from July 24, 2008, to October 4, 2024. This includes most psychologists who treated BCBS patients during that period. There are some exceptions, like providers who exclusively provided services to participants in Medicare, Medicaid, or the Federal Employee Health Benefits Program, and providers employed exclusively by the government. There is also an exclusion for those only providing certain services, which do not appear to include mental health services.

In addition to the July 29, 2025, deadline for filing claims, our December overview article noted the March 4 deadline for opting out of, or excluding yourself from, the settlement class. Opting out is for class members who do not want to have their current or future lawsuits against BCBS companies blocked by the release in the settlement. If you opt out, you cannot file a claim in this settlement and you are not eligible for the policy changes from the settlement described above.

As we noted in December, opting out is important for psychologists who hope or intend to bring antitrust claims against a BCBS company. That is because the settlement’s definition of “released claims” on p. 17 (use numbering at bottom of page) of the Settlement Agreement clearly encompasses claims arising from the same factual basis as the settled antitrust lawsuit. We expect that few psychologists plan on bringing their own antitrust lawsuits.

But broad and vague language in the “released claims” definition creates uncertainty about what other lawsuits against BCBS companies would be blocked if you don’t opt out of the lawsuit. In addition to covering claims known or unknown or arising in the future, the definition includes claims “relating in any way to . . . any issue raised in any of the Provider antitrust lawsuits covered by the settlement by pleading or motion.” This may allow BCBS companies to assert that lawsuits (or your participation in them) are barred because they relate to a variety of issues that came up in 12 years of litigation. This reliance on the details of legal filings to which class members have no access makes it difficult to predict what types of lawsuits might be released. We would argue that the exception in the definition of “released claims” where it is alleged that a BCBS company did not properly pay or deny a claim for service (which is the main type of claim psychologists would likely want to bring) should override that provision, and that settlement materials did not give class members reasonable notice of that provision. Nonetheless, APA Services would not be surprised if BCBS companies aggressively try to block future lawsuits against them based on the broad “pleading or motion” provision.

Accordingly, psychologists should consider whether possible future lawsuits they might want to bring against BCBS companies (or their joining of class actions or other lawsuits against BCBS companies) are at risk from the broad language in the settlement agreement, and the potential additional costs and delay that may accrue if BCBS asserts that those potential claims should be barred. These are decisions you may want to discuss with your counsel.

The steps for excluding yourself from the class are detailed in the settlement FAQopens in new window. The basic steps are that you must mail your request for exclusion, postmarked by March 4, to the address below. Required information includes: your name, contact information, NPI, TIN, and the last 4 digits of your SSN. You must include a statement indicating that you wish to be excluded from the provider Settlement Class in In re: Blue Cross Blue Shield Antitrust Litigation. You must sign it with a physical signature (electronic signatures like DocuSign are not accepted). The request must be mailed to: Blue Cross Blue Shield Provider Settlement, Settlement Notice Administrator, P.O. Box 26443, Richmond VA 23261.

For more information, see the settlement’s FAQ pageopens in new window. You can access the full Settlement Agreement on the Blue Cross Blue Shield Provider Settlement websiteopens in new window. After clicking the link to the homepage, scroll down to the “Important Documents” section, then click on “Settlement Agreement.” Members can also contact us by email.