Dozens of providers have filed new lawsuits against Blues insurers, arguing that the plans colluded to block competition and reimburse them at lower rates.
The payers reached a tentative $2.8 billion settlement agreement in Alabama court in October, but the new lawsuits opt out of it and instead press for a jury trial. The Blue Cross Blue Shield Association and 33 of its affiliates are named in the new suits.
Providers who have signed on to the filings include the University of Pennsylvania Health System, Geisinger, MedStar, CommonSpirit and physician staffing firm TeamHealth. They argue that the alleged collusion between Blues plans violated antitrust laws.
"Defendants colluded for decades to restrict competition for the purchase of healthcare services," according to one of the new complaints, filed in Pennsylvania. "Defendants colluded for one reason: to pay healthcare providers, including Plaintiffs, far less than they would have been paid in a competitive market."
The Blue Cross Blue Shield Association told Fierce Healthcare it does not comment on active litigation.
The ongoing legal fight stretches back a decade, with providers across the country arguing that the Blues network divvied up geographic regions to avoid competing against one another directly. Doing so enabled them to increase insurance costs and lower reimbursements.
Alongside the settlement agreement reached in October, Blues insurers agreed to make changes to the BlueCard program, a provider-facing platform they can use to track claims, file prior authorization requests and submit questions to the insurer.
Under the settlement, Blues plans said they would move the BlueCard platform to the cloud and make payments promptly and with interest should they fall outside of a set window.
But the providers argue in a complaint that they haven't seen any significant change. For example, Blues plans also signed on to a 2020 settlement for $2.7 billion that resolved similar allegations from a slew of consumer lawsuits.
However, in the Pennsylvania complaint, the health systems say they generally have not been approached by Blues plans outside of their geographic region since 2021, signaling they haven't in practice taken steps to compete more directly with one another.
"This would reduce market concentration in the relevant market because the Defendant Insurance Companies would exercise their newfound ability to negotiate price terms and contract with providers in the Exclusive Service Area of other Defendant Insurance Companies," the providers argued.
"Reimbursement prices paid to providers would increase and the market for payment of healthcare services would become much more competitive," they said. "Eliminating the anticompetitive conduct would also improve quality by allowing providers to negotiate price terms and contract with Defendant Insurance Companies with superior and innovative services."