A Blue Cross and Blue Defend firm faces a class-action lawsuit over a nationwide program that requires suppliers contracted with Blue Cross Blue Defend Affiliation members to simply accept charges negotiated by Blues plans from different states.
Blue Cross and Blue Defend of Louisiana should defend itself in opposition to a lawsuit representing suppliers from the Pelican State, Decide John Conery dominated Monday when he upheld a earlier denial of the insurer’s request for abstract judgment.
Opelousas Normal Hospital Authority, a well being system about 60 miles west of Baton Rouge, initiated the lawsuit in 2016. The corporate argues that the Blue Cross Blue Defend Affiliation’s BlueCard Program is an “an unlawful horizontal cartel.” As such, the Opelousas Normal Hospital Authority contends the BlueCard Program protects Blue Cross and Blue Defend of Louisiana’s market share by deterring different Blues plans from working within the state and negotiating their very own cost charges. The lawsuit alleges this system violates state antitrust legal guidelines, depresses supplier pay and will increase affected person prices. All healthcare suppliers that do enterprise with Blue Cross and Blue Defend of Louisiana are eligible to be included within the class motion.
The Blue Cross Blue Defend Affiliation launched the BlueCard Program in 1995, in line with the group’s web site. This system allows Blue Cross and Blue Defend policyholders to obtain care exterior their dwelling states from in-network suppliers contracted with the 36 Blue Cross and Blue Defend corporations affiliated with the affiliation.
Blue Cross and Blue Defend of Louisiana tried to enchantment the choice 4 instances. The insurer argues {that a} state legislation permitting well being plans to increase the phrases of out-of-state insurance policies to clients touring to Louisiana supersede native antitrust legal guidelines.
“The statute doesn’t in any other case, nonetheless, supply BCBSLA an absolute defend from the restraint of commerce prohibition alleged by plaintiff, and which is on the coronary heart of this concern,” Conery wrote in his ruling.
Blue Cross and Blue Defend of Louisiana stated it doesn’t touch upon pending litigation.
The BlueCard Program is beneath menace from separate authorized motion. The Blue Cross Blue Defend Affiliation settled a federal antitrust swimsuit for $2.67 billion in 2020. The settlement permits Blue Cross and Blue Defend corporations to accumulate different Blues plans or enter their markets and lifts a income cap the affiliation imposed on non-Blues-branded insurance policies its associates sells. Plaintiffs who opted out of the deal query whether or not the BlueCard Program is authorized.