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06/11/2025

National Blue Cross Provider Settlement:

Are You Eligible to Receive Funds?

July 29, 2025, Deadline to Submit a Claim for a Share of the Settlement Funds

What You Need to Know

  • Blue Cross Blue Shield has reached a $2.8 billion settlement to resolve an antitrust class action lawsuit brought by health care providers across the nation.
  • If you treated at least one Blue Cross-insured patient between July 24, 2008, and October 4, 2024, you may be eligible to receive settlement funds.
  • The deadline to submit a valid claim is July 29, 2025.
  • For more information, including eligibility, how to submit a claim, and more, go to bcbsprovidersettlement.com.
  • Webinars on how to submit a claim for your share of the settlement proceeds are being offered. If you’re interested sign up here.

In October 2024, a monumental settlement in a longstanding antitrust class action lawsuit filed on behalf of healthcare providers across the nation was announced. The settlement, with all the Blue Cross and Blue Shield entities in the country, as well as the Blue Cross and Blue Shield Association, is the largest antitrust settlement in the history of the United States healthcare industry, and is made up of two elements:

  1. A $2.8 billion settlement fund to reimburse providers; and
  2. A commitment from the Blues to make operational and structural improvements to benefit providers and prevent future anti-competitive conduct.

The underlying lawsuit alleged that the Blues violated the Sherman Antitrust Act of 1890 by illegally dividing the United States into “service areas” and agreeing not to compete in those areas, which limited competition and lowered reimbursement. The Blues deny any wrongdoing but still agreed to the $2.8 billion settlement.

Are You Eligible to Receive Funds?

If you provided healthcare services to any patient who was insured by a plan administered by Blue Cross from July 24, 2008, to October 4, 2024, you are likely an eligible member of the Settlement Class.

To receive payment, members of the Settlement Class must submit a valid claim before the deadline: July 29, 2025.

How Much Could I Receive?

More than three-quarters of the settlement will go to facilities, but at least $224 million has been set aside for professional providers. Payments to members of the Settlement Class are based on a points system corresponding to the Allowed Amounts for their NPI or TIN, as follows:

  • Less than or equal to $250,000 – 1 point
  • More than $250,000, but less than or equal to $500,000 – 2 points
  • More than $500,000, but less than or equal to $750,000 – 3 points
  • More than $750,000, but less than or equal to $1,000,000 – 4 points
  • More than $1,000,000 – 5 points

Claimants will indicate the range containing their allowed amounts on the claim form. A multiplier based on a “harm coefficient” of the geographic area in which the provider is located will then be applied. The final payment formula is as follows:

Adjusted Points ÷ Total Adjusted Points for All Medical Professionals Who Filed Claims × Professional Net Settlement Fund

Distributions will be made after all claims, determinations, and disputes that could impact Claim Payments are resolved.

Based on this formula, and the potential huge number of potential members of the Settlement Class, individual distributions from the fund are likely to be nominal, but the MAC Legal Affairs team recommends that all offices at least explore their options moving forward.

Additional Information

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