Blue Cross Blue Shield Association's tentative $2.8 billion settlement in a class action antitrust lawsuit made headlines for the size of the payout as well as the scope of reforms BCBSA and its 33 member companies will make. PTs are among the health care providers that will benefit from these operational changes, which are largely related to the insurer's BlueCard Program that manages patients insured by one Blue plan but receiving services from a provider in a different Blue plan.
If the settlement obtains approval from an Alabama U.S. District Court, these three changes are among the ways PTs and other providers with patients who are insured by Blue plans could be better off (outside of the monetary payout):
- BCBSA will create guidelines to improve the prior authorization process for services provided to its members.
- Each Blue plan will have a value-based contract offering, giving providers an option between fee-for-service and value-based payment models, which will expand providers' opportunities to enter into value-based contracts.
- Claims processing will be improved under the BlueCard Program, including an appeals form that is common to all Blue plans.
More details are available in the Motion for Preliminary Approval and Reuters news service.