Blue Cross Blue Shield Settlement
On April 27, 2007, physicians announced that they settled with over 90% of all Blue Cross and Blue Shield (BCBS) Plans in the country and the Blue Cross and Blue Shield (BCBS) Association. The list below contains the documents related to the BCBS settlement.
The deadline for submitted claims was October 19, 2007. Any questions regarding the settlement should be directed to the Blues Settlement Administrator at 1-877-893-2643.
A complete list of Blue Cross and Blue Shield Plans can be found at here.
As part of the settlement agreement, BCBS Physician Advisory Committees (PACs)will be established on a state-by-state basis; contact your state medical association for your area's PAC members.
Final Order of Approval issued by Court in Blue Cross Blue Shield Settlement.
On April 19th, 2008, Judge Moreno, of the US District Court for the Southern District of Florida, gave final approval to the Blue Cross Blue Shield Settlement in the action Love, et al. v. Blue Cross Blue Shield Assn, et al. View the order.
Although a Final Order of Approval was issued by Court in Blue Cross Blue Shield Settlement on April 19th, 2008, there is one appeal remaining that is being actively litigated. UNITIL THIS APPEAL IS COMPLETELY RESOLVED, SETTLEMENT FUNDS CAN NOT BE DISTRIBUTED. Please check back periodically for updates.
Blue Cross Blue Shield Settlement Update
- NEW! (7/23/2009) The final appeal in the Blue Cross Blue Shield Settlement was dismissed on June 12, 2009 and as such, the settlement has been finalized. The settlement administrator mailed the settlement checks to class members on July 22, 2009.
- CODING PROVISIONS IN BLUE CROSS BLUE SHIELD ASSOCIATION SETTLEMENT TAKE EFFECT JANUARY 21, 2009
The provisions in the Settlement Agreement reached between physicians and the Blue Cross Blue Shield Association requiring the settling Blues companies to follow most CPT® rules take effect on January 21, 2009. These provisions require:
- Payment of add-on codes without reduction for Multiple Procedure Logic
- Separate recognition and payment of E&M codes appended with a 25 modifier when billed with a service procedure or surgical code
- Separate recognition and payment for supervision and interpretation and radiologic guidance codes
- Payment for codes submitted with 59 modifiers to the extent they follow CPT rules regarding designation of separate procedures
- Prohibition on global periods for surgical procedures longer than CMS
- Prohibition on automatic reduction of CPT codes to codes of lesser intensity
In addition, most of the other provisions in the Blue Cross Blue Shield Association Settlement Agreement have already taken effect. These include, but are not limited to, a prohibition on collecting an alleged overpayment beyond 18 months (or less if a lesser period is specified by state law), 90 days advance notice of material adverse changes, and application of a clinical based definition of medical necessity.
Any physician who believes that a settling Blues company has violated one of these provisions can file a compliance dispute with the Class Compliance Dispute Facilitator, Deborah J. Winegard. She can be reached at (404) 607-8222 or at email@example.com. Download a Compliance Dispute Form (PDF - more info under the compliance section below).
- The Blue Cross Blue Shield Settlement Billing Dispute External Review Board (BDERB) is now operational and available to MDs and DOs who are class members (and did not opt out) of the Love, et al v. BCBSA, et al Settlement dated April 27, 2007.
The BDERB is a national independent review organization contracted to review billing disputes submitted by an MD or DO. You do not have to participate with a settling Blue Cross Blue Shield Plan to submit a billing dispute to BDERB (for a complete list of settling Blue Cross Blue Shield Plans, please visit http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/health-insurer-settlements/blue-cross-blue-shield/blue-cross-blue-settlement.shtml); however, your billing dispute must arise from services provided to members of a settling Blue Cross Blue Shield Plan.
Requirements To Dispute A Blue Cross Blue Shield Decision Using the BDERB:
- You must be a class member who did not opt out of the Love, et al. v. BCBSA, et al. Settlement.
- You must have exhausted all internal billing dispute processes of the settling Blue Cross Blue Shield Plan including any appeals.
- Your dispute must arise from a denial of payment for services provided to members of a settling Blue Cross Blue Shield Plan.
Billing dispute amount must:
- exceed $500 as a single dispute; OR
- be multiple disputes filed within a 1-year period from the filing of the original billing dispute and exceed $500 as an aggregate amount (for more information about this process, see section 7.10(c) of the Settlement Agreement located on this page)
- You must have initiated a provider billing dispute with your Blue Cross Blue Shield Plan and received a written response that you wish to have reconsidered.
- The dispute must be filed within 90 calendar days of the date of the final Blue Cross Blue Shield denial notification.
- You must complete and submit the Blue Cross Blue Shield Dispute Form (see below)
- You must submit the proper filing fee (payment methods include American Express, MasterCard, Visa (debit or credit), and check). Please note the filing fee will not be charged until the $500 threshold billing dispute amount is reached.
- For more information along with detailed instructions, please click on the Blue Cross Blue Shield Settlement Billing Dispute Instructions link below.
Billing Dispute Forms and Instructions:
About the Blue Cross Blue Shield Settlement
Blue Cross Blue Shield Compliance Dispute Information
Blue Cross Blue Shield Court Orders and Settlement Agreement Documents
Blue Cross Blue Shield Official Mailed Notice and Documents
BCBS Mailed Notice, Claim Forms and Claim Form Instructions were mailed to physicians on July 27, 2007.
The Blue Cross Blue Shield Settlement Forms have now been mailed to physicians. Physicians should have received a plain white envelope with a return address referencing the settlement administrators: Blue Parties' Settlement Administrator, PO Box 2876, Portland, Oregon. The documents include the Notice, Claims form and Claims Instruction. One error: Section D of the Claims Form should reference page 4 (not page 3) for the list of eligible charitable organizations. Claim forms were due on October 19, 2007.
BCBS Signatory Societies
List of Blues Plans That Have Not Settled
BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC.
ARKANSAS BLUE CROSS AND BLUE SHIELD
BLUE SHIELD OF CALIFORNIA
BLUE CROSS OF IDAHO HEALTH SERVICE, INC.
BLUE CROSS AND BLUE SHIELD OF KANSAS, INC.
PREMIER HEALTH INC.
BLUE CROSS AND BLUE SHIELD OF KANSAS CITY
BLUE CROSS AND BLUE SHIELD OF NEBRASKA
HEALTHNOW NEW YORK, INC.
BLUE CROSS BLUE SHIELD OF NORTH DAKOTA
NORIDIAN MUTUAL INSURANCE COMPANY
BLUE CROSS & BLUE SHIELD OF WYOMING