Blue Shield $10.5M Reimbursement Claims Settlement

If you were a licensed physician or surgeon (or provider group) who submitted a health care services claim to Blue Shield for emergency or critical care services provided to an enrollee in California at any time from May 7, 2014, to May 30, 2024, you may be eligible to claim monetary and/or other benefits from a class action settlement.

Blue Shield has agreed to pay $10,500,000 to settle a class action lawsuit for alleged unlawful denial of reasonable and customary reimbursement for emergent-designated services performed by non-contracted doctors outside of the emergency department, without first making a reasonable determination as to emergence.

Who can submit a claim?

The Settlement Class includes all licensed physicians and surgeons (including their provider groups) who:

• were not contracted with Blue Shield
• submitted a claim form for professional services rendered to a Blue Shield member
• from May 7, 2014, to May 30, 2024
• provided an affirmative response to Box 24.C (“EMG”) of the CMS Form 1500 (or the 837 electronic claim submission equivalent)
• or reported critical care procedure codes (CPT Code 99291-99292) in Box 24.D of the CMS Form 1500 (or the 837 electronic claim submission equivalent)

How much can class members get?

Class members can claim monetary settlement relief from a fund of up to $10.5 million. The amount each class member receives will be based on the difference between the total reimbursement received from all payors (Blue Shield, subscriber, enrollee) and Blue Shield’s non-contracted, emergency services reimbursement rate or the full-billed amount, whichever is less.

If the total amount claimed by all class members is less than or equal to $10,500,000, each class member will receive the full amount they are entitled to.

If the total amount claimed exceeds $10,500,000, each class member’s payment will be reduced proportionally.

Is proof required to submit a claim?

Yes. Claimants need to confirm that the claim included emergency medical services, confirm that the right to reimbursement has not been fully assigned to someone else, and provide the total amount of reimbursement received from all payors as reflected in their records.

How to claim an award

To file a claim, you can submit your claim online through the online claim form or by mail.

Mail your claim to:

Natuzzi v. Blue Shield Settlement Administrator

c/o Rust Consulting Inc. – 7644

P.O. Box 2599

Faribault, MN, 55021-9599

How do I get paid?

Payments will be made by check mailed to the address provided in your claim form.

$10,500,000 Settlement Fund

The settlement fund of $10,500,000 will cover:

• Monetary relief to eligible class members
• Attorneys’ fees up to $2.75 million
• Advanced expenses up to $120,000
• Service awards of $15,000 to each named plaintiff
• Settlement administration costs estimated at $118,338

Important dates

• Fairness Hearing: October 3, 2024
• Deadline to File a Claim: January 6, 2025

When is the Natuzzi v. Blue Shield payout date?

The earliest possible date for distribution of monetary payments is March 3, 2025.

What happens next?

The next steps include the Fairness Hearing on October 3, 2024, followed by the commencement of the claim submission period on November 7, 2024. If the settlement is approved, eligible class members will receive their payments by March 3, 2025.