CMA is outraged that Blue Shield of California has refused to settle a class-action lawsuit filed in 2003 that would have meant tens of millions of dollars to California physicians who were harmed by the insurer's previous failures to provide and pay for patient care.

Despite the association's best efforts to work amicably with this nonprofit insurance company — a company CMA founded — Blue Shield is demonstrating a disappointing unwillingness to provide its enrollees with the care for which they've paid.

Though not a plaintiff in this case, CMA has been working with the parties involved over the past several months to reach a fair settlement. Unfortunately, the Blue Shield of California board of directors recently decided it was not willing to pay the pro rata shares owed to doctors who provided tens of millions of dollars in uncompensated care to Blue Shield enrollees.

The case, Rick Love, M.D. v. Blue Cross Blue Shield Association, was filed in May 2003 in federal district court in Miami. The suit accused the insurers of a pattern and practice of denying and delaying care, including intentionally programming computer billing databases to automatically downcode physician claims. The suit was filed under the federal civil RICO (Racketeering Influenced and Corrupt Organizations) statutes.

Although CMA is not a plaintiff in the suit, the suit affects all physicians because of its class-action status. Blue Shield of California is one of the few Blue Shield companies in the nation of nearly 40 licensees that has refused to settle this case and pay doctors the money they are owed. Negotiations in a few states are still pending.

Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.