BCBS Settlement Instructions and Materials

To:      PSA Affiliated Practices

From:  John R. Outlaw, Chief Compliance Officer

Re:      Blue Cross Blue Shield Settlement Instructions and Materials -- Deadline: October 19, 2007

SUMMARY: On April 27th of this year, representatives of physicians and state and local medical societies announced a settlement of the national class action lawsuit (known as Love, et al. v. Blue Cross and Blue Shield Ass'n, et al.) involving the Blue Cross Blue Shield Association and most Blue Cross Blue Shield Plans and their current and former subsidiaries (BCBS).  This settlement is another in a long line of similar settlements with various HMO plans over the last 3 years (previous settlements have already been completed with Aetna, Cigna, Health Net, Humana, and WellPoint/Anthem). The deadline for submitting a claim under the BCBS settlement is Friday, October 19, 2007. 

WHO IS ELIGIBLE? You are eligible to file a claim for compensation as a member of the BCBS settlement class if you are (or have been) a physician, physician group or physician organization "who provided Covered Services to any Plan Member or services to any individual enrolled in or covered by a Plan offered or administered by any Person named as a defendant in the Complaint or by any other primary licensee of the BCBSA or by any of their respective current or former subsidiaries or Affiliates" at any time between May 22, 1999 and May 31, 2007.  The attached Settlement Notice includes a list of settling Blue Cross and Blue Shield plans and affiliates.

HOW IS MY SHARE OF THE SETTLEMENT FUND DETERMINED? This settlement with BCBS requires that $131 million be set aside for distribution to physicians who are members of the Class and who file a Claim Form before the October 19, 2007 deadline. This settlement distribution method is very similar to the other HMO settlements in that each member of the class will be entitled to a pro-rata portion of the settlement amount assigned to the following sub-classes:

  • Deceased, retired or otherwise inactive physicians
  • Actively practicing physicians whose gross receipts for calendar years 2002, 2003 and 2004 for providing covered services to health benefit plan members of WellPoint were in the aggregate zero or less than $5000 (this class receives a single share or "base amount", which will not be determined until the total number of claimants is established)
  • Actively practicing physicians whose gross receipts for calendar years 2002, 2003 and 2004 for providing covered services to health benefit plan members of WellPoint were in the aggregate at least $5000, but less than $50,000 (this class receives five times the "base amount")
  • Actively practicing physicians whose gross receipts for calendar years 2002, 2003 and 2004 for providing covered services to health benefit plan members of WellPoint were in the aggregate greater than $50,000 (this class receives ten time the "base amount")

(Note: Actively practicing physicians may also choose to provide documentation to support inclusion in a category or sub-class entitled to a higher payment share based on gross receipts for any other consecutive 3-year period between 1997 and 2006)

 

HOW DO I FILE A CLAIM? In order to qualify for payment under this settlement, you must complete the attached Claim Form. The Form must completed, signed and postmarked no later than October 19, 2005. 

Physician Groups may submit claims on behalf of physicians employed by or otherwise working with them without the necessity of individual signatures from the individual physicians if authorized to do so by such physicians if authorized to do so by the physicians.

If the Group submits the claim, it must be accompanied by a list of all the Active Physicians for whom it is filing. The list must include all of the following data elements:

       Physician Name

       Physician Type (example: MD or DO)

       Last four digits of each Active Physician's Social Security Number (SSN)

       Range of Gross Receipts received from WellPoint for each Active Physicians

-- Range I: Under $5000

-- Range II: $5000 to <$50,000

-- Range III: $50,000 or over

Failure to supply the range of gross receipts for each physician on the list will result in all of your physicians defaulting into the "under $5000" payment group.

For your convenience, copies of the Blue Cross Blue Shield Settlement Notice, Blue Cross Blue Shield Claim Form Instructions and the Claim Form is available on the internet at http://www.BCBSphysiciansettlement.com/documents.html .

Claim Forms should be postmarked not later than October 19, 2007 and submitted to the Settlement Administrator at:

Blue Parties' Settlement Administrator

P.O. Box 4349

Portland, OR 97208-4349

HOW DO I KNOW WHICH CATEGORY OF GROSS RECEIPTS IS APPLICABLE FOR ME? In order to assist our clients with selecting the correct category, PSA is in the process of running reports to identify payments made by Blue Cross and Blue Shield plans from 2004 through 2006 to physicians for which PSA does billing. These reports are certainly not infallible, but represent our best efforts to assist you in this exercise. If PSA has not done your billing for the entire three-year period involved, then you may need to contact your previous billing company or otherwise make your own determination as to the amount of you gross receipts from Blue Cross Blue Shield plans over this 3-year period.  

FOR MORE INFORMATION: Most of the state and local medical societies have very good information on this and other HMO settlements associated with the In re Managed Care Litigation. There are several internet sites which have been established for communicating information on this settlement agreement which you may find helpful. Each of these sites have downloadable copies of all relevant documents and forms. Included among these sites are: www.BCBSphysiciansettlement.com, www.ArchieLamb.com, www.WhatleyDrake.com, www.ktlaw.com  and www.hmosettlements.com.