Blue Cross Plans Settle a Doctors’ Class Action

On Friday, twenty-three Blue Cross and Blue Shield Plans and the Blue Cross and Blue Shield Association (BCBSA) announced that “they have reached an agreement with representatives of a nationwide class of physicians to settle a lawsuit that was filed in U.S. District Court in Miami in 2003” and is known as the Thomas/Love case. Business Insurance reports that in addition to making payments to a compensation fund and attorneys fees

The Blues plans have agreed to make several business practice changes, including implementing a definition of medical necessity that ensures that patients are entitled to receive medically necessary care as determined by a physician exercising clinically prudent judgment; ensuring the payment of valid clean claims within 15 days for electronically submitted claims and 30 days for paper claims; providing fee schedules to physicians; and establishing an independent external review board for resolving disputes with physicians concerning many common billing disputes.

These changes are similar to those accepted by previously settling health insurer defendants. The American Medical Association’s President applauded the settlement, which is now pending approval by U.S. District Judge Moreno in Miami.