Clifford Chance

With the March 4, 2025, opt-out deadline approaching, healthcare providers should carefully evaluate their options under the US$2.8 billion Blue Cross Blue Shield (BCBS) antitrust settlement.

The lawsuit, filed in 2012 by a class of hospitals, physicians, and other healthcare providers, alleges that BCBS and its member plans suppressed competition by, among other things, dividing the U.S. into exclusive service areas and imposing rules that limited revenue from non-BCBS plans. According to the plaintiffs, this conduct drove up insurance costs for subscribers while reducing reimbursements for providers.

What’s in the Settlement?

The settlement has two key components:

• US$2.8 Billion Settlement Fund – Compensating providers for alleged underpayments.
• Operational & Structural (Non-Monetary) Reforms – Measures aimed at preventing future anticompetitive conduct.

How Will the Settlement Fund Be Distributed?

Providers who treated BCBS patients between July 24, 2008, and October 4, 2024, may be eligible for a payout. The fund is divided into two categories:

• 92% to healthcare facilities (hospitals, clinics, etc.).
• 8% to medical professionals (individual providers).

Non-Monetary Reforms

In addition to financial compensation, the settlement includes operational improvements designed to enhance efficiency and transparency, such as:

• A system-wide cloud-based architecture for better access to information.
• New guidelines to improve prior authorization processes.
• An internal messaging system to expedite issue resolution.
• A uniform appeals form to reduce administrative burdens.

Key Deadlines

• March 4, 2025 – Opt-Out Deadline
  Providers must notify the court if they wish to pursue independent litigation instead of accepting a settlement payout.
• July 29, 2025 – Claims Submission Deadline
  Providers who do not opt out must submit claim documentation by this date to secure their share of the settlement.

Should You Opt Out?

While US$2.8 billion is a substantial sum, BCBS processed trillions in reimbursements over the class period, leading some to argue that the settlement may not fully reflect the harm suffered by providers.

Healthcare organizations and physician groups should carefully weigh whether to accept a payout or pursue independent claims. If you have questions about your potential recovery or the best strategy for your organization, contact the Clifford Chance Antitrust team for guidance.