Blues class-action settlement to expire soon

A major class-action settlement between physicians and most of the country's nonprofit BlueCross BlueShield-affiliated plans will expire May 31.

The American Medical Association urged physicians in an April 25 practice management alert to check their contracts with Blues plans to see if the expiration will affect their practices.

The settlement ended class-action cases consolidated from a series of lawsuits filed by physicians in multiple states against the Blues and other large health insurers between 1999 and 2000. Physicians alleged that the insurers, including Aetna, Cigna, Health Net, Humana and WellPoint, conspired to reduce or deny payments for care, violating the federal Racketeer Influenced and Corrupt Organizations Act.

WellPoint, a for-profit parent company that operates Blues plans in 14 states, settled separately from the other Blues plans.

Settlement terms varied, but all required the insurers to pay plaintiffs and change the claims-handling procedures that prompted physicians to sue. Cases against UnitedHealth Group and Coventry Health Care were dismissed.

Most of the country's Blues plans and the BlueCross BlueShield Assn. signed on to the agreement. The plans did not admit wrongdoing.

The Blues agreement, which included a $128 million payment to physicians, required the plans to establish physician advisory committees, revise their claims payment procedures and set up independent review boards to arbitrate billing disputes.

The Blues settlement was finalized in April 2007, but the last appeal wasn't dismissed until June 22, 2009.

Other than the collective Blues, the only plans operating under settlement terms are two Pennsylvania-based Blues plans -- Capital BlueCross and Highmark. Their settlements remain in effect until 2012, said Deborah Winegard, attorney and compliance dispute facilitator.

The two plans settled later than others and were sanctioned for delaying the cases against them by failing to turn over documents to plaintiffs' attorneys for months, and in some cases a year.

Winegard said if physicians believe one of the Blues has violated the agreement, they must file compliance disputes before the May 31 expiration for her to take them up.

"If it is pending as of the time the settlement expires, we'll see it through all the way to its conclusion, even if it's next year," Winegard said.

Some other companies, including Aetna and Humana, have voluntarily extended their compliance with class-action settlement terms after their agreements' expiration, but no Blues plans that settled have said they will do so.