Update on Class Action Lawsuit Settlement

BCBS Compliance Dispute Program Now Operational

By News Staff
10/1/2008

Got a beef with a Blue Cross and Blue Shield health plan? Is it neglecting to fulfill all the terms of the legal settlement agreement reached about 18 months ago?

Stock photo of courtroom with gavel on table in foreground

Physicians who have such concerns and who did not opt out of the settlement agreement are encouraged to file compliance disputes under the compliance dispute program set forth in the terms of the agreement.

Don't delay action. The form must be filed no later than 90 days after the compliance dispute first arose or reasonably could have been known about by the reporting physician.

The compliance dispute claim form (2-page PDF; About PDFs) is now available online; there is no filing charge to physicians. Completed forms should be sent to the newly named compliance dispute facilitator, Deborah Winegard, J.D., (1-page PDF; About PDFs) whose contact information is clearly delineated on the form. Winegard also has served as the compliance dispute facilitator for similar settlements made by Aetna and CIGNA.

The settlement agreement resulted from a class action lawsuit on behalf of nearly 900,000 physicians who alleged that the insurance plans conspired to use unfair payment practices and paid physicians less than they were owed.

Under the terms of the 2007 settlement, (3-page PDF; About PDFs) the Blue Cross and Blue Shield Association and affected Blue Cross health plans were directed to, among other things,

ensure the payment of "clean" claims within 15 days for electronically submitted claims and 30 days for paper claims;
pay for the cost and administration of recommended vaccines;
establish an independent external review board for resolving billing disputes;
provide 90 days' notice of changes in practices and policies;
use clinical guidelines based on credible scientific evidence; and
provide physicians with access to an independent, medical necessity external review process.

In a September press release (1-Page PDF; About PDFs) from the Physicians Advocacy Institute Inc., an organization established to help enforce the managed care settlement, President Robert Seligson, said that the compliance dispute program "assures physicians and patients that the settling Blues plans will keep their commitments to make their business operations transparent and fair, allowing physicians to focus on patient care without the burden of bureaucratic hassles."

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