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A Blue Cross and Blue Shield company faces a class-action lawsuit over a national program that requires providers contracted with Blue Cross Blue Shield Association members to accept rates negotiated by Blues plans from other states.
Blue Cross and Blue Shield of Louisiana must defend itself against a lawsuit representing providers from the Pelican State, Judge John Conery ruled Monday when he upheld a previous denial of the insurer’s request for summary judgment.
Opelousas General Hospital Authority, a health system about 60 miles west of Baton Rouge, initiated the lawsuit in 2016. The company argues that the Blue Cross Blue Shield Association’s BlueCard Program is an “an illegal horizontal cartel.” As such, the Opelousas General Hospital Authority contends the BlueCard Program protects Blue Cross and Blue Shield of Louisiana’s market share by deterring other Blues plans from operating in the state and negotiating their own payment rates. The lawsuit alleges the program violates state antitrust laws, depresses provider pay and increases patient costs. All healthcare providers that do business with Blue Cross and Blue Shield of Louisiana are eligible to be included in the class action.
The Blue Cross Blue Shield Association introduced the BlueCard Program in 1995, according to the organization’s website. The program enables Blue Cross and Blue Shield policyholders to receive care outside their home states from in-network providers contracted with the 36 Blue Cross and Blue Shield companies affiliated with the association.
Blue Cross and Blue Shield of Louisiana attempted to appeal the decision four times. The insurer argues that a state law allowing health plans to extend the terms of out-of-state policies to customers traveling to Louisiana supersede local antitrust laws.
“The statute does not otherwise, however, offer BCBSLA an absolute shield from the restraint of trade prohibition alleged by plaintiff, and which is at the heart of this issue,” Conery wrote in his ruling.
Blue Cross and Blue Shield of Louisiana said it does not comment on pending litigation.
The BlueCard Program is under threat from separate legal action. The Blue Cross Blue Shield Association settled a federal antitrust suit for $2.67 billion in 2020. The settlement allows Blue Cross and Blue Shield companies to acquire other Blues plans or enter their markets and lifts a revenue cap the association imposed on non-Blues-branded policies its affiliates sells. Plaintiffs who opted out of the deal question whether the BlueCard Program is legal.
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