Several Pennsylvania hospital systems have filed a federal class action lawsuit against Blue Cross Blue Shield, accusing the insurance company of restricting competition to pay healthcare providers less than market value. The lawsuit, filed in the District Court for the Eastern District of Pennsylvania, includes plaintiffs such as Lancaster General Hospital, Tower Health, and the University of Pennsylvania Health System (UPHS).
The hospitals allege that Blue Cross Blue Shield has engaged in antitrust violations by agreeing not to compete or negotiate price terms outside of pre-allocated geographic territories. This practice, they claim, has allowed the insurance company to pay providers significantly less than they would receive in a competitive market. According to The Morning Call, the lawsuit also targets the Blue Card program, which standardizes payments across regions, potentially limiting competition and keeping reimbursement rates low.
The lawsuit follows a $2.8 billion settlement that Blue Cross Blue Shield agreed to in 2024 as part of a national class action suit. However, the Pennsylvania plaintiffs opted out of the settlement, seeking potentially greater compensation through individual litigation. The Daily Pennsylvanian reports that similar lawsuits have been filed across the country, with hospitals claiming they have been underpaid by billions since 2008.
Blue Cross Blue Shield, which provides health insurance coverage for over 100 million Americans, has not commented on the ongoing litigation. The hospitals are seeking damages, prejudgment interest, costs, and attorneys' fees, along with relief to prevent future losses.