Blue Cross Blue Shield Plan Financial & Activities News: October 2024

The following Blue Cross Blue Shield announcements are just a few of the company activities from this month.

 

AMI offers continuing market research services to clients on Blue Cross Blue Shield Plans as well as publishing an annual Blue Cross Blue Shield Plans Report that provides comprehensive profiles on each of the 33 BSBS plans as well as the BCBSA organization.

  

Blue Cross Blue Shield has agreed to pay $2.8 billion to resolve antitrust class action claims by hospital systems, physicians and other health providers alleging they were underpaid for reimbursements, the plaintiffs said in an Alabama federal court filing. The health providers first sued in 2012, claiming Blue Cross and its affiliates divided the country into exclusive areas where they did not compete with each other. The lawsuit said the nationwide conspiracy increased the cost of insurance and drove down reimbursements. Under the settlement, Blue Cross will create a system-wide information platform facilitating member benefits, eligibility verification and claims tracking that the attorneys said would lead to more transparency, efficiency and accountability.

 

A first-of-its-kind lawsuit seeking class action status against Anthem Blue Cross and Blue Shield accuses the insurer of intentionally misleading patients by publishing a “ghost network” directory that falsely lists mental health professionals as being in-network when, in reality, they are not. The suit, filed in the Southern District of New York, says the inaccurate and misleading directories led to financial strain, worsened mental health conditions, and undue frustration for those seeking care. The complaint claims that more than 80% of listed providers either do not accept Anthem’s insurance, are unreachable due to non-working phone numbers, or are mislabeled with incorrect specialties. In New York, Anthem operates under trade names including Anthem HealthChoice Assurance, Inc., Anthem Blue Cross and Blue Shield, and Anthem HP, LLC. Before changing its name to Anthem HealthChoice HMO, Inc. in 2024, it operated as Empire HealthChoice Assurance, Inc.; and before that, as Empire HealthChoice Inc; and before that, as Empire Blue Cross and Blue Shield.

 

Scripps Health recently sent letters to more than 125,000 of its patients letting them know that if it is unable to broker what it considers a fair deal with their health insurance company, Anthem Blue Cross, it will allow its contract with the carrier to lapse on Jan. 1, 2025.

 

Emory Healthcare and Anthem Blue Cross and Blue Shield will continue their health care collaboration through 2028 providing access to quality care for the more than 140,000 members the systems serve. As the most comprehensive academic health system in Georgia, Emory Healthcare is dedicated to innovating medicine, teaching the caregivers of the future and providing high-quality health care to patients and their families.

 

Arkansas Blue Cross and Blue Shield announced a new brand within its family of affiliates: Skai Blue Cross Blue Shield. Skai Blue is a new third-party administrator (TPA) that will more broadly support the company’s national business and clients. Drawing on decades of experience solving challenges of some of the nation’s leading companies, Skai Blue was created to strengthen Arkansas Blue Cross’ service model and new market offerings and eliminate geographical barriers when doing business nationally.

 

Blue Shield of California and Salesforce, the #1 AI CRM, are teaming up to solve a significant healthcare challenge — providing physicians and their patients prior authorization answers in near real-time, rather than days. Together, Blue Shield and Salesforce will make prior authorization simpler, faster and more transparent. The platform solution, which will be built on Salesforce Health Cloud, will also connect members to personalized health support by automatically alerting care teams of prior authorization requests.

  

Blue Shield of California announced it has drastically cut the price it will pay for Humira — purchasing the medicine at a transparent net price of $525 per monthly dose, compared to the market reported net price of Humira at $2,100. The innovative agreement with drug manufacturer Fresenius Kabi and Evio Pharmacy Solutions, which facilitated the deal, eliminates the excessive markups often found in a traditional pharmacy benefit manager model. Instead, Blue Shield’s new Pharmacy Care Reimagined model allows the nonprofit health plan — among several other innovations — to provide its members with better access to biosimilar medications. Biosimilar drugs are FDA-approved for providing patients the same clinical effectiveness of a branded version — at a significantly lower, transparent cost.