Highmark Blue Cross Blue Shield has agreed to a $10 million settlement in a class action lawsuit that affects over 900,000 physicians nationwide. This settlement is separate from the earlier Blues parties’ settlements and covers four out-of-state plans, including Highmark Inc., Keystone Health Plan West, Inc., Highmark West Virginia, Inc. (d/b/a Mountain State Blue Cross Blue Shield), and Parker Benefits, Inc.  

Even physicians who did not treat patients covered by one of the settling insurers are eligible to claim a share of the $10 million settlement. The class includes all physicians who billed any of the Blue Shield companies or their contracted intermediaries (capitated medical groups, IPAs, etc.) for services provided between May 22, 1999 and November 19, 2007.

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.

The deadline to submit a claim is February 27. You do not have to provide documentation for individual claims. To receive a share of the settlement, you need only calculate the aggregate payments received from the settling Blue Shield companies from 2004 to 2006. Physicians with $5,000 or less in claims billed to the settling defendants are eligible for one pro rata share; those with $5,001 to $49,999 are entitled to five shares; and those with more than $50,000 will receive 10 shares. The share value will be determined once all claims have been received.

Claims submitted to Blue Shield of California should not be included in the calculations. As you may know, Blue Shield of California refused to settle this lawsuit. Because Blue Shield of California was unwilling to settle, most California physicians will only be entitled to one settlement share. Physicians who have treated a large number of out-of-state Blue Shield patients may be entitled to more.

Settlement notices, including claim forms and filing instructions, were mailed to physicians last week.

• Mailed Notice
• Highmark Claim Form
• Instructions for the Claim Form
• Insert regarding Motion to Move the Fairness Hearing Date

More information is also available on the settlement administrator’s website, http://www.hmosettlements.com.

Contact: Desiree Rice, 916/551-2865 or drice@cmanet.org.