Blue Cross / Blue Shield Settlement
December 1996 — Fast Facts
December 19, 1996
For more information:
Steve Corson, 503-947-7868
Joel Ario, 503-947-7984
The settlement has four parts (All aspects of the settlement are subject to court approval):
- Restitution. Approximately 190,000 BCBSO subscribers may be eligible for refunds, which will total as much as $4.4 million, depending on how many subscribers make valid claims. Analysts
believe approximately 82 percent of the refunds will be less than $25, with the majority of those under $5.
- A civil fine. BCBSO will pay a fine of $100,000 to the state's General Fund.
- Health coverage for children. BCBSO will provide free health care coverage for 3,000 low-income Oregon children for one year, through the insurer's Oregon YouthCare program. The children
covered will be less than 17 years old and belong to Oregon families with household incomes between 100 and 200 percent of the federal poverty level.
- Consumer education. The first $150,000 of unclaimed refunds will go to DCBS for insurance consumer education, research and advocacy.
Who's eligible for refunds?
The following categories of BCBSO policyholders, Capitol Health Care subscribers, and HMO Oregon subscribers, excluding subscribers in the Federal Employees Health Benefits Program, may be eligible
for refunds. The class includes policyholders or subscribers who sustained an actual monetary loss and:
- Who made hospital charge co-insurance payments based on billed amounts rather than discounted amounts for the period from July 1989 through June 1994;
- Who made prescription drug co-insurance payments based on billed amounts rather than discounted amounts for the period from January 1990 through June 1995;
- Who were identified by BCBSO's post-payment audits of hospital bills from July 1989 through June 1995;
- For whom liens or claims involving Medicare/Medicaid "carve-outs" were miscalculated; or,
- For whom calculation of lifetime maximums and deductibles were based on billed amounts rather than discounted amounts, between July 1989 and June 1995.
When will refunds be sent out?
BCBSO will send notices to affected policyholders/subscribers no later than January 30, 1997. If the court approves the settlement, valid claims will be paid later in the year.
Where can I get more information?
Inquiries about the lawsuit or policyholders' rights under this settlement should be made in writing to the attorney for class plaintiffs, Dan W. Clark, at Dole, Coalwell & Clark, P.C., 810 SE Douglas,
Post Office Box 1168, Roseburg, Oregon 97470. Policyholders who do not receive a copy of the notice, and believe that they may be entitled to compensation under the settlement, may also obtain a recorded
update and information about how to obtain a copy of the notice by calling, toll-free, 1-888-207-4211.
Return to the Blue Cross/Blue Shield settlement press release.
