Blue Cross Blue Shield AntiTrust Litigation | Latest News surrounding Insurance Antitrust Litigation | Page 4

Law360 (January 18, 2019, 6:25 PM EST) —

The Alabama federal judge overseeing sweeping antitrust litigation

against the Blue Cross Blue Shield network has said he can no longer wait for the insurance giant’s army of lawyers to marshal themselves into a more manageable group, ordering a dozen attorneys into a “Council of Twelve” to streamline a leadership plan.

In an unusual decision handed down Thursday, U.S. District Judge R. David Proctor took it upon himself to straighten out Blue Cross’ defense team, noting that even though it’s rare for a court to set up lead counsel on the defendants’ side in multidistrict litigation, the court had “reached that point.”

“Since the inception of this litigation, the court has repeatedly requested that the defendants organize themselves in a manner that allows the court to interact with the defendants in a more manageable, representative manner,” Judge Proctor said. “The defendants have been reluctant to scale down their ranks to operate in the streamlined manner envisioned by the court.”

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The Eleventh Circuit Court of Appeals denied the defendants’ petition to appeal Judge David Proctor’s memorandum opinion and order under 28 U.S.C. § 1292(b). Judge Proctor ruled on April 5, 2018 that the plaintiffs Section 1 claims were due to be analyzed under the per se rule.

Click to view the Order: 11th Circuit Order

By Lauren K. Ohnesorge – Senior Staff Writer, Triangle Business Journal

Oct 16, 2018, 11:00am EDT Updated Oct 16, 2018, 2:46pm

A specialty pharmacy just aimed a lawsuit at Blue Cross Blue Shield of North Carolina, accusing the state’s largest health insurer of “wrongfully” nixing its network participation agreement and costing it hundreds of customers in the state.

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By Chad Terhune

Kaiser Health News

August 23, 2018

Ashley Summers said she got an unpleasant surprise in February when she tried to pick up a prescription for her rheumatoid arthritis: Her pharmacy said her insurance had been canceled, even though her premiums were paid.

Summers called Blue Shield of California and got her policy reinstated — then she said it happened again in March and this time, the lapse in coverage dragged on for three months.

Without insurance to cover her medications and doctor visits, her arthritis and fibromyalgia worsened to the point that she could barely walk, she said. In June, she said, the state granted her permission to switch to another insurer.

“This entire mess has been so incredibly stressful,” said Summers, 49, a personal assistant in Los Angeles who had paid $593 a month in premiums. “For Blue Shield just to pull the plug like this is infuriating.”

Around the state, consumers with individual Blue Shield policies, like Summers, say they have been subject to sudden, erroneous cancellations, especially in recent months, forcing them to go without heart medicine, skip vaccinations for their children and pay hundreds of dollars out-of-pocket for other medical care. On social media, customers have described frantic attempts to get their coverage reinstated.

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By:  Brett Kelman

Tennessean

8/14/2018

Eight months into her pregnancy, Halie Gallik is faced with a tough choice: switch hospitals, leaving behind the doctors she has grown to trust, or face a “surprise” bill that could cost thousands.

Gallik, 32, of Nolensville, is expected to give birth to her third child in late September at Williamson Medical Center, a hospital close to home where her two other kids were born. But Gallik’s insurance is shifting beneath her feet, and soon a birth at Williamson may cost her more than ever.

“We already have an established relationship with our doctor and familiarity with that hospital,” Gallik said. “Even though I would go to an in-network doctor at an in-network hospital, now they could still bill me for an extra $2,000 — or potentially more. That’s crazy.”

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By: Kate Winkle

KXAN

AUSTIN (KXAN) — This week, Blue Cross Blue Shield made some adjustments to its emergency room benefits that mean people could have to pay if they went there for a non-emergency.

The company isn’t changing benefits for its Health Maintenance Organization members, but it is making sure visits to the ER and the treatment people received were for “covered emergency care and were medically necessary.” Starting Aug. 6, the company says it’s also taking extra steps to make sure people are billed correctly and reminding customers that they shouldn’t go to an out-of-network ER unless there is a serious or life-threatening issue.

“This means if you go to an out-of-network ER because it is just a convenient place to get care for something that a person with average medical knowledge would know is not an emergency – like a sports physical – then you may have to pay the entire ER bill,” the company wrote in an announcement on its website.

Emergency medicine physicians like Dr. Nicholas Steinour told KXAN in May that they worry the change could keep people from going to the ER if they really need it or may mean they delay while the weigh whether their insurance company will pay for the visit.

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By: Mary Katherine Wildeman

August 6, 2018

The Post and Courier

BlueCross BlueShield of South Carolina wants to increase premiums as much as 13 percent for insurance plans sold on HealthCare.gov.

BlueCross BlueShield of South Carolina is the only health insurance company that sells plans through the federal marketplace in this state. Rates for the new plans, which must comply with the Affordable Care Act, have not yet been approved by the S.C. Department of Insurance.

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By Jenny Deam

August 5, 2018 Updated: August 6, 2018 10:01am

Houston Chronicle

Blue Cross and Blue Shield of Texas will begin a controversial new program Monday in which it will not pay any expenses for an out-of-network emergency room visit if it is later determined the patient should have gone elsewhere for treatment.

The measure was originally set to roll out June 4, but vigorous complaints from the public and physicians, as well as concerns from the Texas Department of Insurance, delayed it for 60 days of further review.

Blue Cross and Blue Shield of Texas officials and TDI confirmed late last week that the deeply contentious program will now launch and that any sticking points have been resolved.

The new measure is expected to affect about 500,000 Texans with Blue Cross and Blue Shield health maintenance organization (HMO) plans.

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By: Angie Stewart

7/11/18

Cliffside Park, N.J.-based Surgery Center of Cliffside alleges Horizon Blue Cross Blue Shield of New Jersey underpaid the center for a lesion procedure by $58,120.40, court documents show.

Here’s what you should know:

1. Surgery Center of Cliffside filed a lawsuit against Horizon Blue Cross Blue Shield of New Jersey and Empire Blue Cross Blue Shield July 3. Empire is a licensee of BCBS.

2. The ASC performed surgery on a patient insured by Empire who had a painful, rapidly growing lesion on the side of her face.

3. In January, prior to the procedure, an Empire representative told Cliffside the insurer would cover 80 percent of Cliffside’s facility charge after the patient met a $200 deductible, according to court documents.

The surgery was billed at $60,800. Horizon paid $2,679.60.

4. Cliffside submitted multiple appeals, and Horizon insisted it “correctly paid-out-of-network pricing and policy due to nonparticipating physicians.”

5. Cliffside contacted Empire to re-verify the patient’s benefits and was again told Empire would reimburse the center for 80 percent of reasonable and customary charges.

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By TAYLOR DOBBS @TAYLORDOBBS

www.sevendaysvt.com

“We’re not a typical nonprofit,” company spokesperson Sara Teachout said of Blue Cross Blue Shield of Vermont. But that’s how the state classifies the locally incorporated insurance company that collects millions of dollars from Vermonters each month — mostly through payroll deductions — to protect them against health care calamity. Its CEO earns more than half a million dollars annually.

Each state-based Blue Cross Blue Shield is a distinct corporation, but together they cooperate in a nationwide network to allow traveling customers to transport their health care coverage from state to state. The U.S. Congress created a special tax designation for the company. While most nonprofits file their federal taxes as 501c organizations, Blue Cross Blue Shield is a 501m. It doesn’t have to file Internal Revenue Service Form 990s as do most 501 orgs, so it’s not in the Vermont Nonprofit Navigator database that Seven Days put together for its “Give and Take” series.

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