Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-2_13-cv-20000/USCOURTS-alnd-2_13-cv-20000-13/pdf.json

Nature of Suit Code: 890
Nature of Suit: Other Statutory Actions
Cause of Action: 28:1331 Fed. Question

---

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

SOUTHERN DIVISION

}

IN RE: BLUE CROSS BLUE SHIELD }

} Master File No.: 2:13-CV-20000-RDP

ANTITRUST LITIGATION }

 (MDL NO.: 2406) } This order relates to the Provider Track

}

MEMORANDUM OPINION AND ORDER PRELIMINARILY APPROVING 

PROVIDER PLAINTIFFS’ SETTLEMENT AND PLAN FOR NOTICE AND 

APPOINTMENT OF SETTLEMENT NOTICE ADMINISTRATOR AND 

SETTLEMENT ADMINISTRATOR

After more than twelve years of litigation and nine years of negotiations, Provider Plaintiffs 

and Defendants have entered into and executed a Settlement Agreement, which, if finally approved 

by the court, would result in the settlement of all of Provider Plaintiffs’ claims against the Settling 

Defendants in the “Provider Actions.”

1

In full and final settlement of the claims asserted against them, the Settling Defendants 

have agreed to make a $2.8 billion payment, change certain of their business practices, and invest 

1 Unless otherwise defined in this Preliminary Approval Order, the capitalized terms used herein shall have 

the same meaning as in the Settlement Agreement. The Settlement Agreement is attached as Exhibit A to Provider

Plaintiffs’ Memorandum of Law in Support of their Motion for Preliminary Approval of Proposed Class Settlement. 

(Doc. # 3192-2). The term “Provider Actions” means: 

“the lawsuits brought by persons and entities within the Settlement Class and consolidated in In re 

Blue Cross Blue Shield Antitrust Litigation, Case No. 13-cv-20000-RDP (MDL No. 2406), 

including the Consolidated Fourth Amended Provider Complaint, which is currently pending in this

court; all actions that may be transferred or consolidated prior to the time Class Notice is mailed; 

and all actions that are otherwise based, in whole or in part, on the conduct alleged in MDL No. 

2406. Appendix B lists those actions as of the Execution Date. In addition to the actions included 

on Appendix B, the case captioned VHS Liquidating Tr., et al. v. Blue Cross of Calif., Case No. 

RG21106600 (Ca. Super. Ct. Alameda Cnty.) shall also be included among the “Provider Actions” 

so long as the plaintiffs to that action do not file timely and compliant written requests for exclusion 

from the Settlement Class in full accordance with the procedure set forth in the Class Notice.” 

(Doc. # 3192-2 at 21). 

FILED

 2024 Dec-04 PM 04:33

U.S. DISTRICT COURT

N.D. OF ALABAMA

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hundreds of millions of dollars in key infrastructure through which Blue Cross and Blue Shield 

Plans can work with healthcare providers. 

This matter is before the court on (1) Provider Plaintiffs’ Motion for Preliminary Approval 

of Proposed Class Settlement (Doc. # 3192), and (2) Provider Plaintiffs’ Motion for Approval of 

a Plan for Notice and Appointment of Settlement Notice Administrator and Settlement 

Administrator (Doc. # 3194). In their first Motion, Provider Plaintiffs seek an order (1) 

preliminarily approving the proposed class settlement of the Provider Plaintiffs’ claims against the 

Settling Defendants, (2) finding that the Settlement Classes are likely to be certified at final 

approval, (3) appointing Provider Co-Lead Counsel, (4) preliminarily approving the Plan of 

Distribution, and (5) setting a Final Approval Hearing. (Doc. # 3192). In their second Motion, 

Provider Plaintiffs seek an order (1) directing notice of the proposed Settlement Agreement 

reached by Provider Plaintiffs and Settling Defendants, (2) appointing BrownGreer PLC as the 

Settlement Notice Administrator, and (3) appointing Special Master Edgar C. Gentle, III as the 

Settlement Administrator. (Doc. # 3194). Provider Plaintiffs have also filed a supplemental brief 

in support of their motions with additional evidentiary support (Doc. # 3207) and provided the 

court with the proposed Notice and Claims Forms. 

The court has carefully considered Provider Plaintiffs’ Motion for Preliminary Approval 

of Proposed Class Settlement (Doc. # 3192), the Settlement Agreement (Doc. # 3192-2), and the 

memoranda of law and exhibits submitted in support thereof. It has also carefully considered 

Provider Plaintiffs’ Motion for Approval of a Plan for Notice, the Memorandum of Law in Support 

of Motion for Approval of a Plan for Notice, and the exhibits and memorandum submitted in 

support thereof (Doc. # 3194), as well as Provider Plaintiffs’ Supplemental Memorandum and 

exhibits (Doc. # 3207). 

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The court gave public notice of the preliminary approval hearing and provided notice of 

how to access the hearing via telephone for those interested persons unable to attend. (Docs. # 

3198, 3208). On November 14, 2024, the court conducted a preliminary approval hearing at which 

it considered these materials as well as additional presentations and arguments made by counsel. 

The court also heard from counsel for certain nonparty out-of-network emergency medicine 

providers who have other pending litigation against certain Defendants and who objected to the 

preliminary approval of the Settlement. For the reasons discussed below, the Motions are due to 

be granted.

I. Procedural History

The first Provider Complaint was filed in this court in 2012. Conway v. Blue Cross & Blue 

Shield of Alabama. (Case No. 12-cv-2532-RDP). That Complaint, like the operative MDL 

Complaint today, challenged, among other things, the Blues’ use of exclusive Service Areas as a 

restraint of trade in violation of the Sherman Act. (Case No. 12-cv-2532-RDP, Doc. # 1). Later 

that year, the Judicial Panel on Multidistrict Litigation centralized Conway and several actions 

filed by Subscriber Plaintiffs in this court in MDL 2406. In 2013, the Provider Plaintiffs filed a 

Consolidated Amended Complaint. (Doc. # 86). 

The parties engaged in significant motions practice directed at the operative complaint. 

These motions raised numerous substantive issues, such as Defendants’ common-law trademark

defense, the appropriate standard of review for the alleged conspiracies, the McCarran-Ferguson 

Act, different states’ filed rate doctrines, lack of personal jurisdiction, and improper venue. The 

court ruled on the merits of many of these motions and, as related to the Blues’ challenges to 

jurisdiction and venue, the court allowed discovery and further briefing. After years of discovery 

on the jurisdiction and venue issues, the court ruled on those motions. The court streamlined the 

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litigation by designating the Alabama cases as bellwethers (not for trial, but for purposes of 

litigation) and the parties began discovery in earnest on the claims in those cases. Provider 

Plaintiffs litigated 26 motions to dismiss, took discovery from 37 Defendants and numerous 

nonparties, and briefed 76 discovery motions. (Doc. # 3192-3). 

Discovery in this case was a massive undertaking. Although the Alabama cases were 

prioritized, the parties also engaged in substantial across-the-board nationwide discovery, which 

was masterfully managed by the Hon. Michael Putnam. The Provider Plaintiffs served discovery 

requests for structured data on every Defendant, and then met and conferred with each Defendant 

regarding that data. The Provider Plaintiffs obtained detailed information on medical claims and 

reimbursements from each of the Defendants, totaling many terabytes of data. With the help of 

their experts, the Provider Plaintiffs then vetted, synthesized, and analyzed that data, using it as an 

input into a highly sophisticated model for hospital reimbursement. (Id.).

Provider Plaintiffs also served requests for documents on each Defendant, and met and 

conferred with the Defendants regarding the scope of the requests. The Defendants produced 75 

million pages of documents, which the Provider Plaintiffs reviewed both manually and through 

technology-assisted review. Manual review alone consumed approximately 134,000 hours of 

attorney time. The Provider Plaintiffs also responded to the Defendants’ requests for discovery, 

which were served on 156 Provider Plaintiffs and nonparties. The Provider Plaintiffs collected, 

reviewed, and produced approximately 1.5 million pages of documents in response to the Blues’ 

requests. (Id.).

Provider Plaintiffs participated in more than 200 depositions of Defendants and nonparties, 

and defended more than 40 depositions of the Provider Plaintiffs’ class representatives and certain 

class members. (Id.).

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The parties participated in more than 30 discovery hearings, as well as monthly status 

conferences, which resulted in 91 discovery orders. Along with Subscriber Plaintiffs, Provider 

Plaintiffs challenged Defendants’ privilege designations for hundreds of thousands of documents. 

Special Master R. Bernard Harwood ultimately de-designated, in whole or in part, over 450,000 

documents from Defendants’ privilege logs. (Id.). He and the “Seal Team” (a group of attorneys 

assembled from both sides of the litigation) performed important and excellent work.

In 2016 and 2017, the parties participated in two “Economics Day” sessions with the court.

During these sessions the parties prepared and presented tutorials, including expert testimony and 

other evidence, to educate the court about the economic theories of the case and the business 

structures of the Blues challenged in this litigation. (Id.).

In 2017, the parties filed cross motions for summary judgment on the standard of review 

applicable to Plaintiffs’ antitrust claims. In 2018, the court ruled that Plaintiffs’ claims relating to 

Exclusive Service Areas, along with other cumulative restraints, should be judged under the per 

se rule, and claims relating to price-fixing through the BlueCard program should be judged under 

the rule of reason. (Doc. # 2063). The court certified that decision for interlocutory appeal and

Defendants petitioned the Eleventh Circuit to hear the appeal. (Id.). The Eleventh Circuit denied 

the petition. In re Blue Cross Blue Shield Antitrust Litig., No. 18-90020, 2018 WL 7152887. (11th 

Cir. Dec. 12, 2018).

In 2019, Provider Plaintiffs moved to certify classes of Alabama providers, which 

Defendants opposed. In connection with their motion for class certification, Provider Plaintiffs 

submitted reports from six expert witnesses. Provider Plaintiffs defended depositions of each of 

their experts, and they deposed nine of Defendants’ experts. Between 2019 and 2021, the parties 

briefed several related Daubert motions. (Id.).

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Following the Blues’ elimination of the National Best Efforts rule in 2021, in connection 

with the Subscriber Settlement, Provider Plaintiffs and Defendants engaged in another round of 

dispositive motions regarding the appropriate standard of review. (Id.). The court also required the 

parties to brief two-sided platform issues following the Supreme Court’s 2018 decision in Ohio v. 

Am. Express Co., 585 U.S. 529 (2018). (Id.).

For nine years, from 2015 to 2024, Provider Plaintiffs and the Blues also engaged in 

mediation sessions with the able assistance of Special Master Ed Gentle and Katherine “Kip” 

Harbison, who oversaw the negotiations through to completion. The parties also engaged Mediator 

Robert Meyer in the latter stages of their negotiations. The parties participated in dozens of inperson mediation sessions and countless calls and virtual meetings. On October 4, 2024, the parties 

executed their Settlement Agreement, which is now before the court. (Id.).

II. Terms of the Settlement Agreement/Class Definitions

The “Settlement Class” is defined as:

“all Providers in the U.S. (other than Excluded Providers, who are not part of the 

Settlement Class) who currently provide or provided healthcare services, 

equipment or supplies to any patient who was insured by, or who was a Member of 

or a beneficiary of, any plan administered by any Settling Individual Blue Plan 

during the Settlement Class Period.”

(Doc. # 3192-2 at 26). The term “Excluded Providers” means:

(i) Providers owned or employed by any of the Settling Defendants; 

(ii) Providers owned or employed exclusively by Government Entities or 

Providers that exclusively provided services, equipment or supplies to 

members of or participants in Medicare, Medicaid or the Federal Employee 

Health Benefits Programs;

(iii) Providers that have otherwise fully released their Released Claims against 

the Releasees prior to the Execution Date, including but not limited to 

Providers that were members of any of the settlement classes in Love v. Blue 

Cross and Blue Shield Ass’n, No. 1:03-cv-21296-FAM (S.D. Fla.); or 

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(iv) Providers that exclusively provide or provided (a) prescription drugs; (b) 

durable medical equipment; (c) medical devices; (d) supplies or services 

provided in an independent clinical laboratory; or (e) services, equipment 

or supplies covered by standalone dental or vision insurance. 

(Doc. # 3192-2 at 14). The “Settlement Class Period” is July 24, 2008, through the “Execution 

Date,” October 4, 2024. (Id. at 26).

A summary of the features of the Settlement includes:

A. Monetary Relief

Under the Agreement, Defendants have agreed to pay $2.8 billion to the Settlement Fund, 

which will include distributions to the Settlement Class, Notice and Administration costs, and any 

Fee and Expense Award. Defendants are not entitled to reversion of any of the Settlement Fund.

(Id. at 25).

B. Injunctive Relief

In addition to the extraordinary monetary recovery, the parties represent that the settlement 

will significantly improve how Providers will interact with the Blues, bringing more transparency

and efficiency to their dealings, and increase Blue Plan accountability. (Id.). This broad relief could 

only have been obtained in a class case involving all parties. The injunctive relief includes changes 

that Providers have been attempting to secure from the Blues for decades, including:

• Transformation of the BlueCard Program infrastructure through the development 

and implementation of a system-wide, cloud-based architecture that will facilitate 

Settlement Class Members’ immediate access to Member benefits and eligibility 

verification information, preauthorization requirements, and claims status tracking;

• BlueCard Prompt Pay Commitment requires the Blues to pay clean, fully insured 

claims within thirty days, provide additional information to enable claims to be 

corrected promptly, and assesses penalties/interest on eligible claims not paid 

promptly;

• Appointment of a BlueCard Executive at each Blue Plan; 

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• Implementation of a real-time Blues internal messaging system to reduce the time 

it takes for the Blues to communicate with each other regarding BlueCard issues;

and 

• Creation of a Blue National Executive Resolution Group to work to identify trends 

and opportunities for further improvement of the BlueCard Program.

(Id. at 35-57). To implement this injunctive relief, the Blues will be required to invest hundreds of 

millions of dollars. (Id.).

In addition, the Settlement Agreement provides for changes to rules governing contracts 

between Providers and the Blues that will allow Providers’ Contiguous Area Contracts to cover 

more Blue Plan Members, and certain hospitals will be eligible to contract with more Blue Plans 

than before. Contiguous Area Contracts may now cover all in-state members. (Id.). Contiguous 

Area Contracting will now expand to include certain Settlement Class Member hospitals within a 

sixty minute drive of an Anchor Hospital already in a contiguous area, creating contracting 

opportunities for hundreds of hospitals. (Id.).

In addition, limits will be placed on Blue Plans’ ability to rent certain of their non-BlueBranded Provider Networks to other Blue Plans while the latter are operating as Greens.

2

(Id.). 

Providers will have access to more information and be able to access that information on a 

more timely basis than ever before and be able to enter into value-based contracts with the Blues. 

(Id.). 

For a period of five years from the Effective Date of the Settlement, a Monitoring 

Committee comprised of members appointed by the Settling Defendants, Provider Co-Lead 

Counsel, and the court will be created to oversee monitoring, compliance, and reporting related to 

2 Greens are businesses operated by Blue entities but Greens do not use the BCBS trademark.

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the injunctive relief. (Id.). The Monitoring Committee will also address Settlement Class Member 

grievances in a timely manner. (Id.).

Despite the fact that this Settlement provides significant injunctive relief, there is no 

mandatory Rule 23(b)(2) Settlement Class. Any class member may opt out. Those who opt out

will, by the terms of the Settlement, opt out of all the benefits of the settlement – i.e., both the 

monetary and the injunctive relief. 

C. Settlement Class Release

In return for the monetary and injunctive relief discussed above and provided for in the 

Settlement, upon the Effective Date of the Settlement, Releasors (Class Representatives and 

Settlement Class Members who do not timely and validly exclude themselves) will have released 

claims (as described more fully below) against the Releasees ((i) Settling Individual Blue Plans, 

(ii) BCBSA, (iii) NASCO, and (iv) Consortium Health Plans, Inc., as well as related entities). (Id. 

at 24-25). 

The Releasors agree to release:

“any and all known and unknown claims ... based upon, arising from, or relating 

in any way to: (i) the factual predicates of the Provider Actions (including but not 

limited to the Consolidated Amended Complaints filed in the Northern District of 

Alabama) including each of the complaints and prior versions thereof, or any 

amended complaint or other filings therein from the beginning of time through the 

Effective Date; (ii) any issue raised in any of the Provider Actions by pleading or 

motion; or (iii) mechanisms, rules or regulations by the Settling Individual Blue 

Plans and BCBSA within the scope of Paragraphs 10-26 [relating to injunctive 

relief] approved through the Monitoring Committee Process during the Monitoring 

Period and that are based on the same factual predicate of the Provider Actions and 

related to the injunctive relief provided by Paragraphs 10-26.” 

(Id. at 22-23). 

Released Claims do not include those claims “that arise in the ordinary course of business 

and are based solely on (a) claims by the Provider in the Provider’s capacity as a plan sponsor or 

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subscriber or (b) claims regarding whether a Settling Individual Blue Plan properly paid or denied 

a claim for a particular product, service or benefit based on the benefit plan document, Provider 

contract, or state or federal statutory or regulatory regimes (including state prompt pay laws),” 

unless those claims are based in whole or in part on the factual predicates of the Provider Actions 

or Released Claims. (Id. at 23). 

This release is similar to the release that the court approved (and that the Eleventh Circuit 

affirmed) in the Subscriber Settlement.

D. Attorneys’ Fees and Expenses and Service Awards

The Settlement Agreement provides that Class Counsel may apply for: (i) an award of 

attorneys’ fees, up to 25% of $2.8 billion (i.e., $700 million), and (ii) reimbursement of expenses 

and costs reasonably and actually incurred in connection with prosecuting the Provider Actions.

Settlement Class Counsel may seek Service Awards for Class Representatives as part of their Fee 

and Expense Application in accordance with Eleventh Circuit practice. (Id. at 64).

The parties’ agreement with respect to attorneys’ fees was reached only after the parties 

had resolved the other substantive terms of the Settlement. 

E. Notice Plan

When the Parties indicated to the Special Master that settlement was imminent, he issued 

confidential requests for proposal to four leading firms with extensive experience in settlement 

administration. (Doc. # 3194-1 at 8). The Parties and the Special Master attended virtual meetings 

with all candidates and received written proposals. (Id.). After evaluating the proposals, and with 

the assistance of the Special Master, Provider Co-Lead Counsel and counsel for Settling 

Defendants selected BrownGreer PLC as the Settlement Notice Administrator. BrownGreer will 

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be responsible for managing and administering the process by which Class Members are notified 

of the Settlement.

BrownGreer is a sophisticated firm with extensive experience in all facets of settlement 

administration. (Doc. # 3194-2 at 4-5). BrownGreer designs notice plans to reach class members 

in the best practicable manner and to inform them in clear terms of the existence of the proposed 

class litigation or settlement, how it affects them, their rights and obligations, the actions they may 

take, any deadlines for acting, and the consequences of acting or failing to act by the deadline.

(Id.). 

Because the Settlement Class in this case is limited to healthcare providers, it is possible 

to build a robust list of potential Class Members from commercially available databases. (Id. at 7). 

These lists generally contain Providers’ contact information, and in some cases may contain 

validated email addresses. Within twenty-one days of entry of the Preliminary Approval Order, 

BrownGreer will begin to email the notices developed by the parties (Doc. # 3209) to potential 

Class Members with valid email addresses, data that is available for a significant portion of the 

Settlement Class. (Doc. # 3194-2 at 8-9). 

Where an email notice proves undeliverable after two attempts, the email address will be 

identified as inactive or invalid, or where the email address information is unavailable, 

BrownGreer will send a postcard notice to the potential Class Member’s mailing address. (Id. at 

9-10). BrownGreer will re-mail all postcard notices that the USPS returns as undeliverable with a 

forwarding address. (Id. at 10). For postcard notices the USPS returns as undeliverable without a 

forwarding address, BrownGreer will attempt to identify an alternative mailing address through 

PacificEast, Dun & Bradstreet, or other data curation companies that specialize in data 

enhancement and address verification. (Id.). After the initial notice distribution, but before the 

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deadline to file claims, BrownGreer will send reminder notice emails and/or postcards to those 

Class Members who have not yet submitted a claim or opted out of the settlement. (Id. at 11).

The email and postcard notices will provide the settlement website address for Class 

Members to visit to read and download the long-form notice prepared by the Parties. (Id.). This 

website, www.BCBSprovidersettlement.com, will also be referenced in all advertising and will 

include the Settlement Agreement. (Id. at 12).

BrownGreer will coordinate with Signal Interactive Media LLC (“Signal”) to implement a 

paid media campaign that will target ancillary healthcare providers in the United States licensed 

to practice after 2008. (Id. at 11; Doc. # 3194-3 at 7-9). This paid media program will be amplified 

by the distribution of a news release on PR Newswire news circuits reaching traditional media 

outlets (television, radio, newspapers, magazines) and national websites. (Doc. # 3194-2 at 10). 

BrownGreer will provide various services to communicate with and support Class 

Members throughout the Notice period, including (1) a toll-free telephone number that offers 

information about the Program in an FAQ format; (2) a monitored email inbox with an autoresponse providing FAQs and responses, with follow-up by a live program agent if requested; and 

(3) a settlement program post office box to receive all physical mail related to the program. (Id. at 

13). BrownGreer and Signal estimate that this notice program will reach more than 70% of Class 

Members directly. (Id. at 14).

The notices will advise Class Members of their right to opt out of or object to the 

Settlement, explain the requirements to opt out or object, and explain the deadlines for doing so. 

(Id. at 13).

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F. Proposed Settlement Administrator

Provider Plaintiffs recommend that Special Master Edgar C. Gentle, III be appointed as 

Settlement Administrator. (Doc. # 3194-1 at 16-17). He and his partner Kip Harbison have been 

intimately involved in this case since its inception, and assisted the parties in reaching the 

Settlement now under consideration. Gentle has comprehensive experience serving as Mediator, 

Special Master, Settlement Trustee, and Claims Administrator in Mass Tort Litigation. (Doc. # 

3192-6 at 8). He has vast experience providing claims administration and financial advice to 

courts, Settling Parties, and Mass Tort Settlements. (Id.). He has helped create and administer over 

$4.5 Billion in Settlements. (Id.). Gentle served as the Escrow Agent for the Breast Implant MDL 

and was responsible for paying out $1.2 Billion in claims to 300,000 claimants. (Id.). The court is 

familiar with many other examples of Gentle’s relevant experience. 

The Settlement Administrator will be responsible for preparing a lifetime budget for Notice 

and Administration Costs for review and approval of the voting members of the Provider Plaintiffs’

Steering Committee; provide quarterly financial reports comparing the budget to actual operation 

results; create and implement accounting internal controls; take reasonable measures to detect 

waste, misappropriation and fraud; and engage an outside financial auditor. Based on itsfamiliarity 

working with Gentle for the last twelve years in this matter and in previous MDLs, the court is

exceedingly confident that he is eminently qualified to fulfill these duties. 

G. Plan of Distribution

An initial step in creating the Plan of Distribution was to determine a fair allocation of the 

Net Settlement Fund among General Acute-Care Hospitals, Other Facilities, and Medical 

Professionals. To assist them in doing so, the Provider Plaintiffs retained the services of Kenneth 

R. Feinberg and Camille S. Biros, who have designed and implemented some of the largest 

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compensation programs in history, including the September 11th Victim Compensation Fund and 

the BP Deepwater Horizon Oil Spill Program, and also served as the Allocation Mediator for the 

Subscriber Settlement.

i. Intraclass Allocation

Feinberg and Biros received information from the Provider Plaintiffs’ experts regarding 

the results of their econometric models relating to impact on different types of providers. (Doc. # 

3192-4 at 5-6). Those experts concluded that healthcare facilities (including General Acute-Care 

Hospitals and Other Facilities) suffered 92% of the impact, and Healthcare Professionals suffered 

8%. (Id.). Factors affecting this calculation were (1) that the experts’ data showed that the impact 

of the Blues’ conduct on healthcare facilities was three and a half times as large as the impact on 

Healthcare Professionals, and (2) approximately 65% of physicians were excluded from the 

Settlement Class because they had released their claims in Love v. Blue Cross and Blue Shield 

Ass’n, No. 1:03-cv-21296-FAM (S.D. Fla.). (Id. at 6-8). 

In addition to hearing from the Provider Plaintiffs’ experts, Feinberg and Biros participated 

in numerous sessions in which representatives of several types of providers were given an 

opportunity to react to the experts’ results and explain any departure from those results they felt 

was justified, including a two-day session in New York that all participants were invited to attend 

in person or virtually. (Id.). 

Provider Co-Lead Counsel also sought the advice of Samuel Issacharoff, a law professor 

at New York University School of Law and an expert in complex litigation, about how to structure 

the settlement’s payout and avoid legal conflicts that had compromised prior mass harm class 

action settlements. (Doc. # 3192-5 at 2-3). Issacharoff has expressed the following views on the 

settlement. By building the settlement from the ground up, and relying on expert advice for 

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allocation of settlement proceeds, Settlement Class Counsel avoided potential conflicts and 

followed a fair process. (Id. at 6). In designing the process of settlement negotiations regarding the 

allocation, the Plaintiffs’ Steering Committee (“PSC”) took care to ensure that all affected 

constituencies in the settlement had advocates and that no one with negotiating authority had either 

the incentive or the ability to trade off the interests of one group in favor of another. (Id. at 4). 

Issacharoff noted that one of the first decisions made was not to try to create subclasses for 

the negotiation process. (Id.). First, because there are many integrated healthcare systems, many 

of the class members fell into multiple groups of providers. (Id.). Therefore, subclasses were not 

permissible as a matter of law because many class members would have been members of multiple 

subclasses. (Id. at 5, 7). Classes (and subclasses) are designed to represent class members, not legal 

claims. (Id. at 5).3 Second, the claims all arose from a uniform set of allegedly anticompetitive 

practices and were presented against the same defendants. (Id.). Third, the settlement process itself 

would have unraveled if discussions were held among a growing number of subgroups, which 

resulted in further subgroups. (Id.). Fourth, the settlement process was organized to secure the 

participation of all affected groups, while avoiding trade-offs among the various groups. (Id.).

The Intraclass Allocation recommended here was based on damage models calculating the 

market effects from the challenged anticompetitive conduct and was developed over time at 

tremendous expense during this long and hotly contested litigation. (Id. at 6). This negotiation

3 A class that is defined by a claim rather than by class members is an improper fail-safe class. See Messner 

v. Northshore Univ. HealthSystem, 669 F.3d 802, 825 (7th Cir. 2012) (defining a fail-safe class as “one that is defined 

so that whether a person qualifies as a member depends on whether the person has a valid claim.”). Although the 

Eleventh Circuit has not explicitly prohibited fail-safe classes, “lower courts in the Eleventh Circuit have cautioned 

against certifying [them].” Mobley v. Cook Out, Inc., 2023 WL 6193012, at *11 (N.D. Ga. July 28, 2023) (quoting 

Etzel v. Hooters of Am., LLC, 223 F. Supp. 3d 1306, 1315-16 (N.D. Ga. 2016)).

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structure avoided two critical potential conflicts. Counsel never shifted funds from one group to 

another to facilitate the class resolution, and the negotiators were never in the position of “robbing 

Peter to pay Paul.” (Id.). Further, the PSC members’ interests were directly aligned with the various 

subcomponents of the affected class of claimants. 

ii. Distribution from the Net Settlement Fund

The Settlement Fund shall be used to pay certain costs and fees prior to determining a net 

amount that is available for distribution to class members (the “Net Settlement Fund”). (Doc. # 

3192-2 at 26-27). The fees and other costs to be deducted from the Settlement Fund include the 

following:

a. The $100 million Notice and Administration Fund. Included within the Notice and 

Administration Fund will be the fees and expenses associated with monitoring and 

compliance. If, prior to entry of the Final Judgment and Order of Dismissal, 

Settlement Class Counsel believes that $100 million plus interest will be 

insufficient to pay for Notice and Administration Costs, Settlement Class Counsel 

may seek approval from the Court to create a Material Loss Contingency Reserve, 

which shall be funded out of the Settlement Fund and will not exceed 2% of the 

Settlement Fund. (Id. at 16, 18-19). 

b. Fee and Expense Awards to Settlement Class Counsel, including attorneys’ fees 

not to exceed 25% of the Settlement Fund, and reimbursement of expenses and 

costs reasonably and actually incurred in connection with prosecuting the Provider 

Actions. (Id. at 64-66).

c. Service Awards to class representatives, if Eleventh Circuit precedent changes to 

permit such awards. 

d. Escrow Account costs (including taxes and tax expenses). (Id. at 60-63).

The Plan of Distribution distinguishes between two types of Providers: Health Care 

Facilities and Medical Professionals. Although each Settlement Class Member will be classified 

as only one type of Provider, Settlement Class Counsel anticipate that some Claimants will submit 

Settlement Claims on behalf of multiple Settlement Class Members, including more than one type 

of Provider. (Doc. # 3207 at 6). As discussed above, the Net Settlement Fund will be allocated as 

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follows: (a) 92% to Health Care Facilities (the “Hospital/Facility Net Settlement Fund”), and (b) 

8% to Medical Professionals (the “Professional Net Settlement Fund”). (Id.). 

The Hospital/Facility Net Settlement Fund and the Professional Net Settlement Fund will

be considered to be and will be treated as separate funds. (Id. at 7). To the extent that Claimants to 

a fund choose not to submit claims, that will result in increased compensation to Claimants who 

submit claims in that fund only, and not to all Claimants overall.

The Settlement Class Period is July 24, 2008 through the Execution Date, which is October 

4, 2024. (Doc. # 3192-2 at 26). For all Settlement Class Members, the distribution from the Net 

Settlement Fund will depend on their “Allowed Amounts,” meaning the amounts allowed by Blue 

Plans for Commercial Health Benefit Products from July 24, 2008 to October 4, 2024. (Doc. # 

3207-1 at 7). There are two methods for calculating a Claimant’s Allowed Amounts: Option A 

(the “Default Method”) or Option B (the “Alternative Method”). (Id.).

Option A (Default Method): The Default Method will be available to Claimants for whom 

the Provider Plaintiffs’ experts have data concerning Allowed Amounts for all or part of the period 

from 2008 to 2015. If a Claimant elects the Default Method, the Provider Plaintiffs’ experts will 

extrapolate the Claimant’s Allowed Amounts for the entire Settlement Class Period, using the 

Consumer Price Index for hospital and related services from 2015 to the end of the Settlement 

Class Period. If the Provider Plaintiffs’ experts do not have sufficient information about a 

Claimant’s Allowed Amounts to extrapolate the Allowed Amounts, the Claimant must use the 

Alternative Method. (Id.).

Option B (Alternative Method): A Claimant may submit data showing its Allowed 

Amounts for each year from 2015 to the end of the Settlement Class Period. If the Provider 

Plaintiffs’ experts lack data for the Claimant’s Allowed Amounts for the period from 2008 to 2014, 

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the Claimant may submit Allowed Amounts for this period as well. The Provider Plaintiffs’ experts 

will work with the Settlement Claims Administrator to extrapolate or interpolate data for years in 

which it is unavailable, using the Consumer Price Index for hospital and related services. If the

Provider Plaintiffs’ experts have data for the period from 2008 to 2014, that data will be used 

unless of course the Claimant submits Allowed Amounts for the period from 2008 to 2014. (Id. at 

7-8).

Due to a lack of necessary data, the Default Method is not available for Claimants located 

in Arizona, Iowa, Louisiana, Maryland, New Jersey, South Dakota, Virginia, the District of 

Columbia and Puerto Rico, as well as Claimants that were not operating prior to January 1, 2015. 

Claimants who submit claims using the Default Method (despite being ineligible to do so) will be 

given an opportunity to resubmit their claims using the Alternative Method. (Id. at 8). When all 

claims have been submitted for Health Care Facilities, the “Hospital/Facility Claim Payment” for 

each general acute-care hospital or other facility will be calculated. (Id. at 9). Claimants submitting 

claims on behalf of Health Care Facilities will also be provided the opportunity to review with the 

Settlement Claims Administrator the Allowed Amounts upon which their Claim Payment is based 

prior to distribution of the Net Settlement Fund. (Id. at 11). The Settlement Claims Administrator’s 

determination is final. (Id.). 

Because medical professionals move over time, their access to their financial records may 

be more difficult, and it is generally less efficient to attempt to extrapolate Allowed Amounts for 

medical professionals, the distribution method for medical professionals will be streamlined to 

permit them to estimate their Allowed Amounts for the Settlement Class Period within certain 

ranges. (Id. at 9). The Provider Plaintiffs’ experts have used a multiple regression model that will 

allow them to estimate a coefficient for each Medical Professional that represents the relative effect 

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of the Defendants’ conduct on Medical Professionals, depending on the geographic locations of 

those Medical Professionals. (Id. at 10). When all claims have been submitted for Medical 

Professionals, the payment will be calculated for each Medical Professional. (Id.).

If there is a balance remaining in the Escrow Account – other than any Fee and Expense 

Award, the Notice and Administration Fund, any Service Award(s), and interest earned thereon –

the Settlement Claims Administrator will, subject to court approval, allocate the balance among 

Settlement Class Members in an equitable and economic fashion, possibly subject to a minimum 

distribution amount to prevent the costs of distribution from depleting the distribution itself. (Id.

at 12).

III. Applicable Legal Standards

The parties have asked the court to preliminarily certify the Settlement Class and 

preliminarily approve the Settlement. The court briefly sets forth the relevant standards of review

that apply to these requests. 

A. Preliminary Class Certification 

As the Supreme Court has explained, when a plaintiff requests class certification for 

purposes of a settlement-only class, the court:

need not inquire whether the case, if tried, would present intractable management 

problems [] for the proposal is that there is to be no trial. But other specifications 

of the Rule – those designed to protect absentees by blocking unwarranted or 

overbroad class definitions – demand undiluted, even heightened, attention in the 

settlement context. Such attention is of vital importance, for a court asked to certify 

a settlement class will lack the opportunity, present when a case is litigated, to 

adjust the class, informed by the proceedings as they unfold.

Amchem Prods., Inc. v. Windsor, 521 U.S. 591, 620 (1997); see Ortiz v. Fibreboard Corp., 527 

U.S. 815, 848-49 (1999) (“When a district court, as here, certifies for class action settlement only, 

the moment of certification requires heightened attention to the justifications for binding the class 

members.”) (internal citation omitted).

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“For a class action to be certified, the named plaintiff must have standing, and the putative 

class must satisfy both the requirements of Federal Rule of Civil Procedure 23(a), and the 

requirements found in one of the subsections of Rule 23(b).” Cordoba v. DIRECTV, LLC, 942 

F.3d 1259, 1267 (11th Cir. 2019) (internal quotations omitted) (citing City of Hialeah v. Rojas, 

311 F.3d 1096, 1101 (11th Cir. 2002)). The Rule 23(a) requirements for certification of any class 

action are: “(1) numerosity (‘a class [so large] that joinder of all members is impracticable’); (2) 

commonality (‘questions of law or fact common to the class’); (3) typicality (named parties’ claims 

or defenses ‘are typical ... of the class’); and (4) adequacy of representation (representatives ‘will 

fairly and adequately protect the interests of the class’).” Amchem, 521 U.S. at 613; Vega v. TMobile USA, Inc., 564 F.3d 1256, 1268 (11th Cir. 2009) (same); Valley Drug Co. v. Geneva 

Pharms., Inc., 350 F.3d 1181, 1187-88 (11th Cir. 2003) (same). The Federal Rules provide that a 

“class action may be maintained if Rule 23(a) is satisfied and if” the provisions of Rule 23(b)(1), 

(b)(2), or (b)(3) are satisfied. Fed. R. Civ. P. 23(b). Thus, “[i]n addition to establishing the 

requirements of Rule 23(a), a plaintiff seeking class certification must also establish that the 

proposed class satisfies at least one of the three requirements listed in Rule 23(b).” Little v. TMobile USA, Inc., 691 F.3d 1302, 1304 (11th Cir. 2012); see also Palm Beach Golf Ctr.-Boca, Inc. 

v. Sarris, 311 F.R.D. 688, 698 (S.D. Fla. 2015); Diamond v. Hastie, 2019 WL 1994467, at *4 (S.D. 

Ala. 2019).

Provider Plaintiffs seek certification under Rule 23(b)(3) for a class seeking damages and 

injunctive relief. Under Rule 23(b)(3), the movant must show (1) that the questions of law or fact 

common to the class members predominate over any questions affecting individual members, and 

(2) that a class action is superior to other available methods for fairly and efficiently adjudicating 

the controversy. Fed. R. Civ. P. 23(b)(3).

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In Vega, the Eleventh Circuit instructed that:

Although the trial court should not determine the merits of the plaintiffs’ claim at 

the class certification stage, the trial court can and should consider the merits of the 

case to the degree necessary to determine whether the requirements of Rule 23 will 

be satisfied. Valley Drug Co., 350 F.3d 1181 at 1188 n. 15 (citing Gen. Tel. Co. of 

the Southwest v. Falcon, 457 U.S. 147, 160, 102 S. Ct. 2364, 2372, 72 L.Ed.2d 740 

(1982)); see Coopers & Lybrand v. Livesay, 437 U.S. 463, 469 & n. 12, 98 S. Ct. 

2454, 2458 & n. 12, 57 L.Ed.2d 351 (1978) (“[t]he class determination generally 

involves considerations that are ‘enmeshed in the factual and legal issues 

comprising the plaintiff’s cause of action.’ ... ‘The more complex determinations 

required in Rule 23(b)(3) class actions entail even greater entanglement with the 

merits.’”) (emphasis and citations omitted); Huff v. N.D. Cass Co. of Ala., 485 F.2d 

710, 714 (5th Cir. 1973) (en banc) (“It is inescapable that in some cases there will 

be overlap between the demands of [Rule] 23(a) and (b) and the question of whether 

plaintiff can succeed on the merits.”); [Castano v. Am. Tobacco Co., 84 F.3d 734, 

744 (5th Cir. 1996), abrogated in part on other grounds by Bridge v. Phoenix Bond 

& Indem. Co., 553 U.S. 639, 128 S. Ct. 2131 (2008)] (“Going beyond the pleadings 

is necessary, as a court must understand the claims, defenses, relevant facts, and 

applicable substantive law in order to make a meaningful determination of the 

certification issues.”).

Vega, 564 F.3d at 1265-66 (footnotes omitted). The “party seeking class certification has the 

burden of proof.” Brown v. Electrolux Home Prods., Inc., 817 F.3d 1225, 1233 (11th Cir. 2016) 

(citing Valley Drug Co., 350 F.3d at 1187).

B. Preliminary Approval of the Settlement 

If preliminary class certification under Rule 23(a) and (b) is appropriate, the court’s job is 

not complete. Even when Rule 23(a) and (b) are satisfied, the court “must then examine the 

propriety of settlement.” In re Blue Cross Blue Shield Antitrust Litig., 2020 WL 8256366, at *6 

(N.D. Ala. Nov. 30, 2020) (quoting Hale v. Manna Pro Prod., LLC, 2020 WL 3642490, at *2 

(E.D. Cal. July 6, 2020)). As this court explained in preliminarily approving the Subscriber 

Settlement:

Rule 23(e) provides that a court may approve a proposed class action settlement 

“only after a hearing and on finding that it is fair, reasonable, and adequate.” See

Rule 23(e)(2). The 2018 amendments to Rule 23(e)(2) brought forth substantial and 

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needed changes with respect to the early and final evaluation of class settlements.4

Rule 23(e) now provides that the district court may approve a settlement only after 

considering whether:

(A) the class representatives and class counsel have adequately represented the 

class;

(B) the proposal was negotiated at arm’s length;

(C) the relief provided for the class is adequate, taking into account:

(i) the costs, risks, and delay of trial and appeal;

(ii) the effectiveness of any proposed method of distributing relief to the 

class, including the method of processing class-member claims;

(iii) the terms of any proposed award of attorney’s fees, including timing of 

payment; and

(iv) any agreement required to be identified under Rule 23(e)(3); and

(D) the proposal treats class members equitably relative to each other.

In re Blue Cross Blue Shield Antitrust Litig., 2020 WL 8256366, at *6-7 (citing Hale, 2020 WL 

364, 2490, at *3 (quoting Fed. R. Civ. P. 23(e)(2)(A)-(D))). 

IV. Analysis

As explained above, the motions before the court require the court to address the Rule 23(a) 

and (b) requirements for class certification and consider the overall fairness, reasonableness, and 

adequacy of the proposed settlement. Below, the court analyzes the propriety of class certification 

and the parties’ proposed settlement. But first, the court considers two preliminary matters that are 

critical to certification: standing and ascertainability.

4 The 2018 amendments to Rule 23 impose a heightened standard on counsel seeking preliminary approval 

of a proposed settlement. Now, before notice of a proposed settlement is given to a class, counsel must provide the 

court with “a solid record supporting the conclusion that the proposed settlement will likely earn final approval after 

notice and an opportunity to object.” Fed. R. Civ. P. 23 advisory committee’s notes to 2018 amendment. Specifically, 

counsel must demonstrate the proposed settlement passes procedural and substantive hurdles. Rule 23(e)(2)(A-B) 

requires counsel demonstrate the proposed settlement has satisfied certain “‘procedural’ concerns,” and Rule 

23(e)(2)(C-D) requires the proposed settlement satisfy a “‘substantive’ review.” Id.

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A. Standing

“It is well-settled in the Eleventh Circuit that prior to the certification of a class, and before 

undertaking an analysis under Rule 23, the district court must determine that at least one named 

class representative has Article III standing to raise each class claim.” In re Terazosin 

Hydrochloride Antitrust Litig., 220 F.R.D. 672, 679 (S.D. Fla. 2004) (citing Wolf Prado-Steiman 

v. Bush, 221 F.3d 1266, 1279 (11th Cir. 2000)); Griffin v. Dugger, 823 F.2d 1476, 1482 (11th Cir. 

1987) (“[A]ny analysis of class certification must begin with the issue of standing.”)). Indeed, 

“[o]nly after the court determines the issues for which the named plaintiffs have standing should 

it address the question whether the named plaintiffs have representative capacity, as defined by 

Rule 23(a), to assert the rights of others.” Griffin, 823 F.2d at 1482. “To have standing, a plaintiff 

must show (1) he has suffered an injury in fact that is (a) concrete and particularized and (b) actual 

or imminent, not conjectural or hypothetical; (2) the injury is fairly traceable to conduct of the 

defendant; and (3) it is likely, not just merely speculative, that the injury will be redressed by a 

favorable decision.” Kelly v. Harris, 331 F.3d 817, 819-20 (11th Cir. 2003).

Defendants have not challenged Provider Plaintiffs’ standing in this case and, further,

Provider Plaintiffs easily satisfy the necessary elements of standing. Plaintiffs have presented 

evidence that, due to Defendants’ alleged anticompetitive agreements, they have suffered injuries 

in the form of lack of competition in the relevant healthcare markets, including being unable to 

contract with Defendants in contiguous states, and receiving reduced reimbursement rates. 

Provider Plaintiffs have presented evidence from reputable economics experts that their injuries

are concrete, particularized, and actual, not merely conjectural. There is also evidence that the 

injuries are traceable to agreements between Defendants, and that it is likely that the elimination 

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of certain challenged restraints will remedy those injuries. Accordingly, the court is satisfied the 

named Provider Plaintiffs have standing.

B. Ascertainability

In addition to standing, a class plaintiff must show that the proposed class is adequately 

defined and clearly ascertainable. Little, 691 F.3d at 1304. The threshold issue of “ascertainability” 

relates to whether the putative class can be identified. “An identifiable class exists if its members 

can be ascertained by reference to objective criteria.” Bussey v. Macon Cnty. Greyhound Park, 

Inc., 562 F. App’x 782, 787 (11th Cir. 2014) (citing Fogarazzo v. Lehman Bros., Inc., 263 F.R.D. 

90, 97 (S.D.N.Y. 2009)). These “objective criteria” should be “administratively feasible,” meaning 

that the identification of class members should be “a manageable process that does not require 

much, if any, individual inquiries.” Id. at 787 (citation omitted) (reversing district court decision 

finding the ascertainability requirement satisfied where class could not be identified by reference 

to objective information in the defendant’s records). A plaintiff can rely upon a defendant’s records 

to identify class members. Karhu v. Vital Pharms., Inc., 621 F. App’x 945, 948 (11th Cir. 2015).

Because the Settlement Class in this case is limited to healthcare providers, the settlement 

administrator will be able to build a robust list of potential Class Members from commercially 

available databases. These databases include lists of Providers maintained by associations, such as 

the American Medical Association and the American Hospital Association; lists of Providers 

maintained by the government, such as the National Provider Identifier (“NPI”) registry; and 

vendors such as Definitive Healthcare, a provider of commercial healthcare data and analytics. In 

particular, Definitive Healthcare maintains a list of individual Providers with nearly three million 

entries, covering not only medical doctors but many other types of providers as well. These lists 

generally contain Providers’ contact information, and in some cases contain validated email 

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addresses. Based on this information, the court is satisfied that the identification of putative Class 

Members will be administratively feasible.

C. The Rule 23(a) Requirements

Before certifying a class, even where a settlement is involved, a district court must analyze 

the requirements of Rule 23. Amchem Prods. Inc. v. Windsor, 521 U.S. 591, 619-20 (1997). 

Pursuant to Rule 23, class certification is appropriate if:

(1) the class is so numerous that joinder of all members would be impracticable; (2) 

there are questions of fact and law common to the class; (3) the claims or defenses 

of the representatives are typical of the claims and defenses of the unnamed 

members; and (4) the named representatives will be able to represent the interests 

of the class adequately and fairly.

Valley Drug Co. v. Geneva Pharms., Inc., 350 F.3d at 1181, 1188 (11th Cir. 2003); Fed. R. Civ. 

P. 23(a)(1)-(4).

1. Numerosity

Under Rule 23(a)(1), the plaintiff must show that the settlement class is so numerous that 

joinder is impracticable. See Rule 23(a)(1). The Eleventh Circuit has held that the numerosity 

requirement is “a generally low hurdle” and “less than twenty-one is inadequate [and] more than 

forty [is] adequate....” Vega v. T-Mobile USA, Inc., 564 F.3d at 1256, 1267 (11th Cir. 2009). Based 

on information from the American Hospital Association and the American Association of Medical 

Colleges, the settling parties estimate that in the United States there are more than 6,000 hospitals, 

several thousand other medical facilities, and hundreds of thousands (or more) physicians and 

other professionals. (Doc. # 3192-1 at 36). Therefore, the proposed classes easily meet the 

numerosity requirement of Rule 23(a)(1).

2. Commonality

Rule 23(a)(2) requires that “there are questions of law or fact common to the class.” Fed. 

R. Civ. P. 23(a)(2). For commonality to be found, the action “must involve issues that are 

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susceptible to class-wide proof.” Williams v. Mohawk Indus., Inc., 568 F.3d 1350, 1355 (11th Cir. 

2009) (citing Murray v. Auslander, 244 F.3d 807, 811 (11th Cir. 2001)). Also, a plaintiff must 

“demonstrate that the class members ‘have suffered the same injury.’” Walmart Stores, Inc. v. 

Dukes, 564 U.S. 338, 350 (2011) (citation omitted). However, Rule 23(a)(2) “demands only that 

there be questions of law or fact common to the class. This part of the rule does not require that all 

the questions of law and fact raised by the dispute be common.” Vega, 564 F.3d at 1268; see also 

Carriuolo v. General Motors Co., 823 F.3d 977, 984 (11th Cir. 2016) (“even a single common 

question will” satisfy the commonality requirement). Courts in the Eleventh Circuit “have 

consistently held that allegations of price-fixing, monopolization, and conspiracy by their very 

nature involve common questions of law or fact.” In re Delta/AirTran Baggage Fee Antitrust 

Litig., 317 F.R.D. 675, 694 (N.D. Ga. 2016) (citations omitted).

Here, like the Subscriber Plaintiffs asserted, Provider Plaintiffs have alleged that 

Defendants engaged in a nationwide conspiracy to horizontally allocate geographic markets by 

agreeing to exclusive service areas where the Blue Plans do not compete with each other and that 

they have imposed other anticompetitive restraints, such as restraints on output in the form of the 

(now abrogated) National Best Efforts rule. Therefore, Provider Plaintiffs’ claims involve several 

common questions of law or fact, including: (1) whether the Blues conspired to allocate markets 

and agreed to restrict output in violation of the Sherman Act, (2) whether the Blues agreed to fix 

prices and implement a group boycott through the BlueCard Program in violation of the Sherman 

Act, (3) whether the Blues monopsonized the relevant product markets, (4) whether the Blues paid 

anticompetitive reimbursements to Providers as a result of their agreements, (5) whether the Blues 

have procompetitive justifications that outweigh the harm to competition for the Provider 

Plaintiffs’ rule of reason claims, and (6) whether the Blues constitute a single entity for purposes 

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of managing their trademarks. The Blues have denied these allegations, but it is clear that there are 

common issues as to all members of all proposed classes that satisfy the commonality requirement. 

3. Typicality

Rule 23(a)(3) provides that class representatives may sue on behalf of the class only if the 

“claims or defenses of the representative parties are typical of the claims or defenses of the class[.]” 

Fed. R. Civ. P. 23(a)(3). “[T]he typicality requirement is permissive; representative claims are 

‘typical’ if they are reasonably co-extensive with those of absent class members; they need not be 

substantially identical.” In re Checking Acct. Overdraft Litig., 275 F.R.D. 666, 674 (S.D. Fla. 

2011) (citing Brown v. SCI Funeral Servs. of Fla., Inc., 212 F.R.D. 602, 605 (S.D. Fla. 2003)). 

Whereas commonality looks at whether class members’ claims are common to each other (a 

horizontal comparison between members of the class), typicality is satisfied where the named

plaintiffs’ claims “arise from the same event or pattern or practice and are based on the same legal 

theory” as the claims of the class (a vertical comparison between class members and class 

representatives). Kornberg v. Carnival Cruise Lines, Inc., 741 F.2d 1332, 1337 (11th Cir. 1984), 

cert. denied, 470 U.S. 1004 (1985).

“‘Where an action challenges a policy or practice, the named plaintiffs suffering one 

specific injury from the practice can represent a class suffering other injuries, so long as all the 

injuries are shown to result from the practice.’” In re Checking Acct. Overdraft Litig., 286 F.R.D. 

645, 653 (S.D. Fla. 2012) (quoting Baby Neal for and by Kanter v. Casey, 43 F.3d 48, 58 (3d Cir. 

1994) (citation omitted)). Typicality is not destroyed by factual variations between the class 

representatives and the unnamed class members. Kornberg, 741 F.2d at 1357; see also Williams v. 

Mohawk Indus., Inc., 568 F.3d at 1350, 1357 (11th Cir. 2009). 

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The Provider Class Representatives include various types of Providers, but their claims are 

typical of the class because they arise from the same alleged conduct: Defendants’ alleged illegal 

geographic market allocation and output restrictions, among other restraints. That alleged conduct, 

along with the challenged price-fixing and group boycott aspects of the BlueCard system, affected 

competition in the markets for the purchase of healthcare services and the sale of commercial 

healthcare financing services, harming the Settlement Class. (Doc. # 2454-6 at 116-254). 

The Class Representatives seek the same relief sought by absent Class Members. The proof 

that Provider Plaintiffs would present to support their claims directly supports the claims of the 

Class. Because Provider Plaintiffs’ claims can be established by common proof of Defendants’ 

application of their restrictive policies, and because the Class Representatives and Settlement Class 

Members appear to have suffered the same injuries and damages, the court finds that typicality is 

satisfied. 

4. Adequacy of Representation

Rule 23(a)(4) requires a showing that “the representative parties will fairly and adequately 

protect the interests of the class.” Fed. R. Civ. P. 23(a)(4). The adequacy-of-representation 

requirement is satisfied when (i) the class representatives have no interests conflicting with the 

class; and (ii) the representatives and their attorneys will properly prosecute the case. Sosna v. 

Iowa, 419 U.S. 393, 403 (1975); Valley Drug Co., 350 F.3d at 1189. 

“Significantly, the existence of minor conflicts alone will not defeat a party’s claim to class 

certification: the conflict must be a fundamental one going to the specific issues in controversy” 

to preclude certification. Valley Drug Co., 350 F.3d at 1189. “A conflict is ‘fundamental’ when, 

for example, some class members claim to have been harmed by the same conduct that benefitted 

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other class members.” 3 William B. Rubenstein, Newberg and Rubenstein on Class Actions § 7:31 

(6th ed. 2024).

The interests of the Class Representatives and the Settlement Class are fully aligned. They 

all share an identical interest in proving that the Blues’ agreements were unlawful, and that the 

Blues’ agreements injured them. The applicable law is uniform federal law. “By relying principally 

on federal substantive law, the representative plaintiffs followed the pattern of antitrust and 

securities litigation, where nationwide classes are certified routinely even though every state has 

its own antitrust or securities law, and even though these state laws may differ in ways that could

prevent class treatment if they supplied the principal theories of recovery.” In re Mex. Money 

Transfer Litig., 267 F.3d 743, 747 (7th Cir. 2001). And, Class Counsel have informed the court 

that all of the current Class Representatives have reviewed the Settlement Agreement and approve 

of its terms, as witnessed by their signatures on the Agreement. (See Doc. # 3192-2 at 135-53). 

The court finds that neither the Class Representatives, nor their counsel, have any interests 

that are antagonistic to those of the absent class members. Each named Plaintiff, like each absent 

class member, has a strong interest in proving that Defendants’ agreements were unlawful, in 

demonstrating the impact of that conduct, and in obtaining redress. the Class Representatives thus 

share the interests of the class and will properly and adequately represent the class. 

In 2013, before appointing Interim Co-Lead Counsel in this case, the court conducted an 

independent review of the applicants and found that those appointed were best suited to represent

the interests of the class. The court has become exceedingly familiar with the lawyers representing

the class over the last twelve years and is fully satisfied that the named Plaintiffs and the lawyers 

representing them have properly and adequately prosecuted this case and well represented the 

class. Therefore, the adequacy-of-representation requirement is satisfied.

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D. Rule 23(b)

Provider Plaintiffs seek certification only under Rule 23(b)(3) for a class seeking damages 

and injunctive relief. Therefore, Provider Plaintiffs must show that “questions of law or fact 

common to class members predominate over any questions affecting only individual members, 

and that a class action is superior to other available methods for fairly and efficiently adjudicating 

the controversy.” ).” AA Suncoast Chiropractic Clinic, P.A. v. Progressive Am. Ins. Co., 938 F.3d 

1170, 1174 (11th Cir. 2019).

1. Predominance

“Common issues of fact and law predominate if they have a direct impact on every class 

member’s effort to establish liability and on every class member’s entitlement to injunctive and 

monetary relief.” Williams v. Mohawk, Indus., Inc., 568 F.3d 1350, 1357 (11th Cir. 2009). The 

predominance standard is similar to the commonality requirement of Rule 23(a), but it is more 

demanding and mandates particular caution where “individual stakes are high and disparities 

among class members great.” Amchem, 521 U.S. at 623; see Carriuolo v. Gen. Motors Co., 823 

F.3d 977, 985 (11th Cir. 2016) (describing predominance in a similar way). The predominance 

requirement “tests whether proposed classes are sufficiently cohesive to warrant adjudication by 

representation.” Carriuolo, 823 F.3d at 985 (quoting Amchem, 521 U.S. at 623). The Eleventh 

Circuit has described how the court should analyze the predominance factor as follows:

To determine whether the requirement of predominance is satisfied, a district court 

must first identify the parties’ claims and defenses and their elements. See Klay,

382 F.3d at 1254 & n.7. The district court should then classify these issues as 

common questions or individual questions by predicting how the parties will prove 

them at trial. See id. at 1255. Common questions are ones where “the same evidence 

will suffice for each member,” and individual questions are ones where the 

evidence will “var[y] from member to member.” Blades v. Monsanto Co., 400 F.3d 

562, 566 (8th Cir. 2005).

Brown v. Electrolux Home Prods., Inc, 817 F.3d 1225, 1234 (11th Cir. 2016). 

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Provider Plaintiffs have alleged a nationwide conspiracy in which Defendants applied the 

alleged restraints in the same way in every state in which Class Members reside. (Doc. # 1083). 

At issue here is whether those uniform, nationwide restraints violated the Sherman Act. (Id.). 

Provider Plaintiffs have submitted evidence showing that these restraints caused antitrust injury to 

all types of healthcare providers, and the court has already denied a motion for summary judgment 

arguing that Provider Plaintiffs other than hospitals had not shown antitrust injury. (Doc. # 3102).

“[T]he predominance requirement is satisfied here because common questions present a 

significant aspect of the case and can be resolved for all Settlement Class Members in a single 

adjudication.” In re Checking Account Overdraft Litig., 275 F.R.D 654, 660 (S.D. Fla. 2011) 

(finding predominance satisfied for settlement certification purposes where “each Settlement Class 

Member’s claims arise from the same or similar alleged [Bank of America] policies and practices 

and the same legal theories” and “the relationship between Settlement Class Members and [Bank 

of America] is governed by substantially uniform or similar account agreement”). Here, each Class 

Member’s claims arise from substantially similar and uniform Blue policies and practices. 

Therefore, the court concludes that Provider Plaintiffs have satisfied the predominance 

requirement.

2. Superiority

The superiority requirement of Rule 23(b)(3) requires the court to consider “the relative 

advantages of a class action suit over whatever other forms of litigation might be realistically 

available to the plaintiffs.” Klay v. Humana, Inc., 382 F.3d 1241, 1269 (11th Cir. 2004). Rule 

23(b)(3) contains a list of factors to consider when making a determination of superiority:

(A) the class members’ interest in individually controlling the prosecution or 

defense of separate actions;

(B) the extent and nature of any litigation concerning the controversy already begun 

by or against class members;

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(C) the desirability or undesirability of concentrating the litigation of the claims in 

the particular forum; and

(D) the likely difficulties in managing a class action.

Fed. R. Civ. P. 23(b)(3).

There are thousands of hospitals and other facilities, and hundreds of thousands of 

healthcare professionals in the Settlement Class. Provider Plaintiffs spent tens of millions of 

dollars on experts to collect, clean up, synthesize, and analyze data just to calculate the damages 

suffered by Alabama hospitals. (Doc. # 3192-3 at 10). If an individual hospital system were to file 

an individual action against the Blues, they would need to repeat this process for every geographic 

market in which they allegedly sustained damages. The cost of litigating these cases is exorbitant.

It would be enormous for a large health care provider and, for smaller healthcare providers, the 

cost would simply be prohibitive. There is a substantial question whether the potential individual 

recovery for Settlement Class Members is large enough to warrant the burden, expense (both 

temporal and monetary), and risk5of prosecuting individual Sherman Act claims. See Wolin v. 

Jaguar Land Rover N. Am., LLC, 617 F.3d 1168, 1175 (9th Cir. 2010) (“Where recovery on an 

individual basis would be dwarfed by the cost of litigating on an individual basis, this factor weighs 

in favor of class certification.”). Thus, it is clear that a class action is not only superior to individual 

actions, but probably the only feasible method of resolving all claims against the Settling 

Defendants.

Having carefully considered the predominance and superiority factors, the court concludes 

that the proposed classes are substantially likely satisfy the relevant requirements of Rule 23(b)(3).

5 A looming question that has cast its shadow over this litigation is whether a jury could be convinced that, 

with the skyrocketing costs of healthcare, medical providers are underpaid in their reimbursement rates.

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E. Preliminary Approval of Settlement Terms

As noted above, “[i]f preliminary class certification is appropriate, the court must then 

examine the propriety of settlement.” Hale v. Manna Pro Prod., LLC, 2020 WL 3642490, at *2 

(E.D. Cal. July 6, 2020). “The [c]ourt may not resolve contested issues of fact or law[] but instead 

is concerned with the overall fairness, reasonableness, and adequacy of the proposed settlement as 

compared to the alternative of litigation.” Swaney v. Regions Bank, 2020 WL 3064945, at *3 (N.D. 

Ala. June 9, 2020) (quoting Turner v. Murphy Oil USA, Inc., 472 F. Supp. 2d 830, 843 (E.D. La. 

2007)). 

Although a court need not make a final determination of the fairness, reasonableness, and 

adequacy of the proposed settlement at this stage of the proceedings, it must make a preliminary 

finding that the proposed settlement is sufficiently fair, reasonable, and adequate on its face to 

warrant presentation to the class members. See William B. Rubenstein, Newberg on Class Actions 

§ 11:25 (4th ed. 2002) (citing The Manual for Complex Litigation § 30.41 (3d ed. 1995)) (“If the 

preliminary evaluation of the proposed settlement does not disclose grounds to doubt its fairness 

or other obvious deficiencies ... the court should direct that notice under Rule 23(e) be given to the 

class members of a formal fairness hearing, at which arguments and evidence may be presented in 

support of and in opposition to the settlement.”).

A district court may only approve a settlement upon finding that it “is fair, adequate and 

reasonable and is not the product of collusion between the parties.” Bennett v. Behring Corp., 737 

F.2d 982, 986 (11th Cir. 1984) (quoting Cotton v. Hinton, 559 F.2d 1326, 1330 (5th Cir. 1977)). 

In making this determination, district courts have traditionally considered the following factors: 

“(1) the likelihood of success at trial; (2) the range of possible recovery; (3) the point on or below 

the range of possible recovery at which a settlement is fair, adequate, and reasonable; (4) the 

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complexity, expense, and duration of the litigation; (5) the substance and amount of opposition to 

the settlement; and (6) the stage of proceedings at which the settlement was achieved.” Id. The

2018 amendments to Rule 23(e) added a mandatory, but not exhaustive, list of similar approval 

factors. Because these factors overlap, it is appropriate to address them together. See Drazen v. 

Pinto, 106 F.4th 1302, 1330 (11th Cir. 2024). 

Further, in considering whether the proposed settlement satisfies the “fair, adequate and 

reasonable” standard, “the trial court is entitled to rely upon the judgment of experienced counsel 

for the parties.” Cotton, 559 F.2d at 1330.

1. Class Representatives and Class Counsel Adequately Represented the 

Class 

For the same reasons discussed above related to Rule 23(a)(4)’s adequacy of representation 

standard, the court preliminarily finds that the Class Representatives and Class Counsel have 

adequately represented the class under Rule 23(e)(2)(A). Settlement Class Counsel have 

vigorously, professionally, and successfully represented the interests of the Settlement Class for 

the last twelve years in both hard-fought litigation and intense settlement negotiations. The court 

is well-acquainted with their performance in this case and has no hesitation in concluding that 

Settlement Class Counsel and the Class Representatives have more than adequately represented 

the Settlement Class.

2. There Was No Fraud or Collusion, and the Settlement Was Negotiated 

at Arm’s Length

Rule 23(e)(2)(B) requires the court to determine whether a proposed settlement “was 

negotiated at arm’s length.” Relatedly, one of the Bennett factors requires the court to rule out the 

possibility of fraud or collusion behind the settlement. Leverso v. SouthTrust Bank of AL., Nat. 

Assoc., 18 F.3d 1527, 1530 (11th Cir. 1994).

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The scope of settlement negotiations in this case – which included scores of in-person 

meetings, along with hundreds of calls and Zoom conferences over the course of nine years – is a 

strong indication that there was no collusion and that the Settlement was negotiated at arm’s length. 

Indeed, every material provision was extensively negotiated. (Doc. # 3192-3 at 10-13). And the 

court’s Special Master, who acted as one of the mediators and helped finalize the Provider 

Settlement, has attested that there was no fraud or collusion involved. (Doc. # 3192-6).

3. This Settlement Will Avert Years of Highly Complex and Expensive 

Litigation Involving Significant Costs, Risks, and Delay

This litigation is extraordinarily complex. It has involved questions of personal 

jurisdiction, the appropriate antitrust standard of review (the rule of reason or the per se standard), 

trademark law, and even the concept of two-sided platforms – a body of law that did not exist 

when the first Provider case was filed. If this case were to proceed to trial, the court would be 

required to decide numerous Daubert motions before the court would even be in a position to 

address a motion to certify a class of Alabama Providers. Given the inevitable appeals (some 

interlocutory) of such a ruling and the likelihood of further dispositive motions practice after class 

certification, a trial of just the Alabama classes’ claims is years away. For any cases that would be 

remanded to the transferor courts, or filed after remand, resolution may be even farther away. The 

massive discovery in this MDL did not focus on jurisdictions other than Alabama. Experts would 

need to be commissioned to analyze these other markets. It would take many years to complete 

these cases, and even when completed in the trial court, the parties undoubtedly face years of 

appeals of class certification decisions, verdicts, and/or decisions on the merits. Any potential 

future recovery must be discounted significantly to account for the immense time and expenses it 

would take to put plaintiffs in a position to receive any recovery.

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There also exist risks that experts would be excluded and classes not certified. This process 

would have to be repeated in each relevant market. If the parties continue to litigate these cases, 

they would need to devote additional significant time and enormous resources to preparing various 

complex damages models. There is simply no guarantee that Provider Plaintiffs would recover a 

final judgment more favorable than the considerable $2.8 billion in monetary relief and

extraordinary injunctive relief secured by them in the Settlement. 

Moreover, when the court preliminarily approved the Subscriber Plaintiffs’ settlement in 

November 2020, the National Best Efforts (“NBE”) rule was still in effect. That rule was one of 

the “aggregation of competitive restraints” that justified applying the per se standard of review to 

the Blues’ conduct. In re Blue Cross Blue Shield Antitrust Litig., 308 F. Supp. 3d 1241, 1267 (N.D. 

Ala. 2018). Provider Plaintiffs face an altered Blue business structure with the removal of NBE in 

connection with the Subscriber Settlement, and the court has held that, “for the period of time 

following the elimination of the NBE rule (after April 2021), the court concludes that it must apply 

the rule of reason analysis to Providers’ Market Allocation Conspiracy claims.” (Doc. # 2933 at 

13). And, as to most of the injunctive relief that Provider Plaintiffs have obtained through 

settlement, there is more than a risk that this relief would not be achieved through further litigation. 

The significant improvements to the BlueCard Program may not be the type of relief a court could 

award even if Provider Plaintiffs were to prevail at trial. Only through settlement with all of the 

Blue Plans could such an outcome have been achieved.

Another critical consideration that became readily apparent through the years the Providers 

and the Blues were mediating the Provider Track of this MDL is that the Blues were and are 

interested in a complete settlement with the Providers – nothing less.6

6 Parties are aware, for a substantial period of time the Blues prioritized a Subscriber settlement over any 

Provider resolution because, in the words of the previous CEO of BCBSA, they did not want to “fight with their 

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Thus, after careful review, the court preliminarily finds that the costs, risks, and delays of 

trials and appeals support the appropriateness of the decision to settle.

4. Stage of the Proceedings/Development of the Factual Record

“The stage of the proceedings at which a settlement is achieved is ‘evaluated to ensure that 

Plaintiffs had access to sufficient information to adequately evaluate the merits of the case and 

weigh the benefits of settlement against further litigation.’” M.D. v. Centene Corp., Inc., 2020 WL 

7585033, at *7 (S.D. Fla. Oct. 7, 2020) (quoting Saccoccio v. JP Morgan Chase Bank, N.A., 297 

F.R.D. 683, 693 (S.D. Fla. 2014) (in turn quoting Lipuma v. Am. Express Co., 406 F. Supp. 2d 

1298, 1324 (S.D. Fla. 2005))). “Nevertheless, early settlements are favored and ‘vast formal 

discovery need not be taken.’” Centene Corp., 2020 WL 7585033, at *7 (quoting Saccoccio, 297 

F.R.D. at 694). 

Here, there is no question that this is an appropriate stage of the litigation at which to 

evaluate settlement. Vast discovery has been undertaken in this litigation spanning over twelve 

years. In that time, Provider Plaintiffs have reviewed Defendants’ production of more than 75 

million pages of documents; taken, defended, or attended more than 200 depositions of Defendants 

and nonparties; collected and reviewed documents in response to the Defendants’ requests for 

production from 156 Provider Plaintiffs and nonparties; and defended more than 40 depositions of 

Provider Plaintiff class representatives and putative class members. With their experts, the 

Provider Plaintiffs have built a sophisticated damages model that required the production, 

customers.” So, if the individual providers were to bring their own actions, the court suspects that the Blues would 

litigate each one to its conclusion rather than enter into piecemeal settlements. The prospect of resolving this case on 

a class wide basis has produced the strongest Settlement, and achieved results that would not have been possible in 

individual litigation.

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synthesis, and analysis of many terabytes of health insurance claims data. This would be expensive 

and difficult to replicate.

Thus, it is clear that the factual record in this matter was sufficiently developed to allow 

Class Counsel to make a reasoned judgment as to merits of the Settlement. Swaney v. Regions 

Bank, 2020 WL 3064945, at *5 (N.D. Ala. June 9, 2020) (holding that settlement was appropriate 

where the parties “have litigated this case for over seven years, through dispositive motions” and 

“have had the opportunity to investigate the facts and law, review substantive evidence relating to 

the claims and defenses, and brief the relevant legal issues”).

5. The Benefits Provided by the Settlement Appear to be Fair, Adequate 

and Reasonable When Compared to the Range of Possible Recovery

The second and third Bennett factors are “easily combined and normally considered in 

concert.” Camp v. City of Pelham, 2014 WL 1764919, at *3 (N.D. Ala. May 1, 2014). “The 

[c]ourt’s role is not to engage in a claim-by-claim, dollar-by-dollar evaluation[] but to evaluate the 

proposed settlement in its totality.” Lipuma, 406 F. Supp. 2d at 1323. 

Without question, the Settlement provides significant monetary relief to class members. 

Provider Plaintiffs believe that the $2.8 billion Settlement Amount represents the largest recovery 

in an antitrust class action that did not result from a governmental investigation, and it is larger 

than the Subscriber Plaintiffs’ settlement fund, which this court approved and the Eleventh Circuit 

affirmed. In addition, the Blues will make investments of hundreds of millions of dollars in system 

improvements for the benefit of class members.

Provider Plaintiffs’ experts estimated damages for Alabama General Acute-Care Hospitals 

for the period from July 24, 2008 to April 15, 2019. Their estimates ranged from $1.46 billion to 

$4.63 billion. Notably, Blue Cross and Blue Shield of Alabama has the highest market share of 

any Blue Plan in the United States. Thus, a similar damages estimate in other markets with greater 

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competition would be lower. Moreover, although Providers believe their experts showed that a 

damages class of Alabama hospitals could be certified (a proposition the Blues contest), there is 

no guarantee that their analysis would lead to the same result in all geographic markets. Providers’ 

expert reports also offered a damages model only for General Acute-Care Hospitals. Their 

subsequent work has shown that the effect of the Blues’ market share on healthcare professionals 

is approximately three and a half times lower than the effect on healthcare facilities.

Settlements reflecting even a small percentage of a potential recovery fall within the range 

of reasonable recoveries. Bennett, 737 F.2d at 986-87 n.9 (approving $675,000 settlement 

representing 5.6% of claims with maximum potential recovery of $12,000,000); In re Checking 

Acct. Overdraft Litig., 830 F. Supp. 2d at 1346 (“[S]tanding alone, nine percent or higher 

constitutes a fair settlement even absent the risks associated with prosecuting these claims.”). By 

whatever measure, the $2.8 billion monetary settlement is more than reasonable. 

Of course, the monetary recovery is only part of the value of the Settlement. Settlement 

Class Members will benefit from a comprehensive transformation of the BlueCard Program, 

saving administrative costs and improving their ability to recover payment for their services for 

years to come. The Blues will invest hundreds of millions of dollars to implement this 

transformation. The Settlement expands the ability of certain hospitals to contract with more than 

one Blue Plan, removes a significant restriction on Contiguous Areas Contracts with another Blue 

Plan, and limits the ability of a Blue Plan to rent certain Non-Blue Branded Provider networks to 

another Blue Plan. 

Settlement Class Counsel were well-positioned to evaluate the strengths and weaknesses 

of the claims in this case as well as the appropriate basis on which to settle them. Because of the 

uncertainties surrounding continued litigation and the fact that settlement provides for certain, 

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significant, and immediate relief, the court concludes that the recovery provided for in the Provider 

Settlement Agreement is an excellent achievement.

6. Opposition to the Settlement

The fifth Bennett factor considers the substance and amount of any opposition to the 

settlement. Bennett, 737 F.2d at 986. Class Counsel have informed the court that all of the current 

Class Representatives7have reviewed the Settlement Agreement and approve of its terms, as 

witnessed by their signatures on the Agreement. (See Doc. # 3192-2 at 135-53). The court finds 

that the unanimous approval of the Settlement by the current Class Representatives indicates 

preliminary approval is appropriate.8

F. Other Relevant Issues

At the Preliminary Approval Hearing, a number of other issues were addressed. Although 

they do not fit neatly within the Rule 23(e)(2) and Bennett factor analysis, the court finds they are 

relevant to the fairness, adequacy, and reasonableness of the Settlement and has considered them.

7 The court previously dismissed the claims of certain Provider Class Representatives who were also members 

of the settlement classes in Love v. Blue Cross and Blue Shield Ass’n, et al., No. 1:03-cv-21296-FAM (S.D. Fla.) 

(“Love”). The Love Providers Class Representatives were Charles H. Clark III, M.D., Robert W. Nesbitt, M.D., Luis 

R. Pernia, M.D., Corey Musselman, M.D., Julie McCormick, M.D., L.L.C., Harbir Makin, M.D., Hillside Family 

Medicine, LLC, Ear, Nose & Throat Consultants and Hearing Services, P.L.C., and Kathleen Cain, M.D. (Doc. # 

2902; Conway v. Blue Cross and Blue Shield of Ala., et al, Case No. 2:12-cv-02532-RDP, Doc. # 457 at 559).

8 There has been one objection to the Settlement. On the night before the preliminary approval hearing, certain 

Non-Party Out-Of-Network Emergency Medicine Providers (“Out-of-Network ER Groups”) filed an Objection to 

Preliminary Approval of Proposed Class Settlement and Motion for 30-Day Continuance of Preliminary Approval 

Hearing. (Doc. # 3211). After meeting and conferring with the parties to the Settlement, on November 22, 2024, the 

Out-of-Network ER Groups filed an Amended Objection. (Doc. # 3217). Their Objection asserts that:

all of the named class Plaintiffs are in-network providers. The proposed class definition includes, 

however, not just in-network providers, but also out-of-network providers, including emergency 

medicine services providers. As described below, the record lacks a sufficient showing of (1) 

typicality because of the unique rights and interests of out-of-network emergency services providers, 

or (2) the adequacy of the named plaintiffs to represent the interests of out-of-network emergency 

services providers.

(Doc. # 3217 at 2). The court has addressed this objection in a separate order of the court. (Doc. # 3224).

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1. Proposed Attorneys’ Fees

Provider Plaintiffs’ Settlement Agreement handles attorneys’ fees similarly to the 

Subscribers’ Agreement. Like Subscribers, Providers have committed to seek attorneys’ fees of no 

more than 25% of the settlement fund, plus expenses and the attorneys’ fees and costs associated 

with administering the settlement’s provisions. This is a similar percentage to that which the court 

preliminarily approved for the Subscribers Settlement, and it is in line with the Eleventh Circuit’s 

benchmarks. See Faught v. Am. Home Shield Corp., 668 F.3d 1233, 1243 (11th Cir. 2011) (noting 

“well-settled law from this court that 25% is generally recognized as a reasonable fee award in 

common fund cases”); Swaney, 2020 WL 3064945, at *7 (“In determining an award of attorney’s 

fees in a percentage-of-fund class settlement case, the ‘benchmark’ percentage is 25%, which is 

the dead center of the 20-30% range.”). 

Settlement Class Members will receive notice of the proposed fee and expense request and 

will have an opportunity to object to any such award prior to final approval. Providers’ ultimate

request will of course be subject to court approval and will receive intense scrutiny.

The Agreement also provides for a Partial Award of $75 million to be paid from the Escrow 

Account to Settlement Class Counsel no later than 45 days after entry of the Final Judgment and 

Order of Dismissal, subject to protections that ensure repayment of the Partial Award if the Fee 

and Expense Award is reduced below $75 million, or return of the Escrow Account is required. 

(Doc. # 3192-2 at 64-65). The court approved a similar provision in the Subscribers’ Agreement 

that required the payment of $75 million to class counsel even earlier – after preliminary approval. 

The court concludes that Provider Plaintiffs’ “quick pay” agreement should be approved for the 

same reasons. Providers have engaged in twelve years of hard-fought litigation, and the early 

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distribution does not prejudice the class members because counsel will likely receive the same 

percentage of the common fund if final approval is granted.

Therefore, the court finds that both the proposed attorneys’ fees and the parties’ agreement 

for a “quick pay” partial payment of attorneys’ fees are fair and reasonable.

2. The Plan of Distribution

A plan of distribution should be approved when it allocates relief in a way that is “fair, 

adequate, and reasonable.” See In re Chicken Antitrust Litig. Am. Poultry, 669 F.2d 228, 241 (5th 

Cir. 1982); see also Holmes v. Cont’l Can Co., 706 F.2d 1144, 1147 (11th Cir. 1983); In re 

Sunbeam Sec. Litig., 176 F. Supp. 2d 1323, 1328 n.2 (S.D. Fla. 2001); Bellocco v. Curd, 2006 WL 

4693490, at *2 (M.D. Fla. Apr. 6, 2006); Smith v. Floor and Decor Outlets of Am., Inc., 2017 WL 

11495273, at *5 (N.D. Ga. Jan. 10, 2017). A plan of distribution will pass muster so long as “it 

has a ‘reasonable, rational basis,’ particularly if ‘experienced and competent’ class counsel support 

it.” MCLAUGHLIN ON CLASS ACTIONS, § 6.23 (17th ed. 2020); see also Schwartz v. TXU 

Corp., 2005 WL 3148350, at *21 (N.D. Tex. Nov. 8, 2005) (approving a plan of allocation that 

“resulted in a settlement agreement that fairly and rationally allocates the proceeds of the 

settlement”).

The allocation of the Net Settlement Fund to the different types of Providers is based on 

the relative impact of the Blues’ conduct on each type of Provider, and it was recommended by 

Feinberg and Biros after many different types of Providers were given an opportunity to comment 

on the allocation. The use of relative harm estimates prepared by the Provider Plaintiffs’ experts 

will result in distributions that are proportional to the alleged impact of the Defendants’ conduct 

on each healthcare facility. And, if they prefer, these facilities can submit their own claims based 

on Allowed Amounts. Professionals will be permitted to estimate their Allowed Amounts within 

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pre-defined ranges, which will minimize the burden of submitting a claim but allow them to receive 

a distribution based on the magnitude of their business with the Blues.

“‘[A] plan of allocation need not be perfect.’” In re LIBOR-Based Fin. Instruments 

Antitrust Litig., 327 F.R.D. 483, 496 (S.D.N.Y. 2018) (quoting Hart v. RCI Hosp. Holdings, Inc., 

2015 WL 5577713, at *12 (S.D.N.Y. Sept. 22, 2015)). “Rather, ‘[a]n allocation formula need only 

have a reasonable, rational basis, particularly if recommended by experienced and competent class 

counsel.’” In re LIBOR-Based Fin. Instruments, 327 F.R.D. at 496 (quoting In re Wachovia Equity 

Sec. Litig., 2012 WL 2774969, at *5 (S.D.N.Y. June 12, 2012)); see also In re Omnivision Techns., 

Inc., 559 F. Supp. 2d 1036, 1043 (N.D. Cal. 2009) ( “[t]he recommendations of plaintiffs’ counsel 

should be given a presumption of reasonableness.” (quoting Boyd v. Bechtel Corp., 485 F. Supp. 

610, 622 (N.D. Cal. 1979)). Here, the Plan of Distribution is based on an expert damages model, 

was mediated before experienced allocation mediators with the input of affected class members, 

and was recommended by experienced and competent class counsel. Therefore, the court 

concludes that the proposed Plan of Distribution allocates the Net Settlement Fund in a fair, 

adequate, and reasonable manner.

Accordingly, based on the information presently before the court, it appears that the Plan 

of Distribution should be preliminarily approved as fair, reasonable, and adequate.

3. Class Notice and Claim Forms

Rule 23(e) requires a court to “direct notice in a reasonable manner to all class members 

who would be bound” by the proposed Settlement. Fed. R. Civ. P. 23(e)(1). Rule 23(c)(2) requires 

a court to “direct appropriate notice to the class.” Fed. R. Civ. P. 23(c)(2)(A). With regard to Rule 

23(b)(3) classes, the Rule states that:

the court must direct to class members the best notice that is practicable under the 

circumstances, including individual notice to all members who can be identified 

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through reasonable effort. The notice may be by one or more of the following: 

United States mail, electronic means, or other appropriate means. The notice must 

clearly and concisely state in plain, easily understood language: (i) the nature of the 

action; (ii) the definition of the class certified; (iii) the class claims, issues, or 

defenses; (iv) that a class member may enter an appearance through an attorney if 

the member so desires; (v) that the court will exclude from the class any member 

who requests exclusion; (vi) the time and manner for requesting exclusion; and (vii) 

the binding effect of a class judgment on members under Rule 23(c)(3).

Fed. R. Civ. P. 23(c)(2)(B). Thus, the Rule requires that “[i]ndividual notice must be sent to all 

class members whose names and addresses may be ascertained through reasonable effort” and that 

the “notice must be ‘reasonably calculated, under all the circumstances, to apprise interested 

parties of the pendency of the action and afford them an opportunity to present their objections.’” 

Eisen v. Carlisle & Jacquelin, 417 U.S. 156, 173-74 (1974) (quoting Mullane v. Cent. Hanover 

Bank & Tr. Co., 339 U.S. 306, 314 (1950)). “In every case, reasonableness is a function of 

anticipated results, costs, and amount involved.” In re Nissan Motor Corp. Antitrust Litig., 552 

F.2d 1088, 1099 (5th Cir. 1977). Reasonableness also depends on the information available to the 

parties. See id. at 1098.

After a competitive bidding process, Settlement Class Counsel retained BrownGreer PLC 

as the Settlement Notice Administrator. BrownGreer has extensive experience in all aspects of 

notice and settlement design and implementation. The Notice Plan entails direct notice efforts and 

supplemental publication notice targeted to healthcare professionals. The direct notice is estimated 

to reach over 70% of known Class Members. After the initial notice distribution, but before the 

deadline to file claims, BrownGreer will send reminder notice emails and/or postcards to those 

Class Members who have not yet submitted a claim or opted out of the settlement. BrownGreer 

will also provide various services to communicate with and support Class Members throughout 

the Notice period. 

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The email and postcard Notices will provide the settlement website address,

www.BCBSprovidersettlement.com, for Class Members to visit so they can read and download 

the long-form notice prepared by the Parties. (Doc. # 3194-2 at 10). The website will also be 

referenced in all advertising and will include the Settlement Agreement. (Id. at 12). The notices 

are designed to come to the attention of the class; are written in clear, concise, easily understood 

language; describe the nature of the action and define the class; provide specific instructions Class 

Members need to follow to properly exercise their rights; and contain sufficient information for a 

class member to make an informed decision. The notices advise Class Members of their right to 

opt out of or object to the Settlement, explain the requirements to opt out or object, and list the 

deadlines for doing so. Feinberg and Biros have reviewed the proposed claim forms and 

instructions for both Healthcare Facilities and Medical Professionals. They have provided their 

opinion that the forms are reasonable, do not require more information than necessary to process 

claims, and are well-designed with clear and prominent information. (Doc. # 3207-2 at 4-5). 

Email notice campaigns supplemented by U.S. mail for class members who do not have an 

e-mail address, or when an e-mail is returned as undeliverable, is appropriate. See, e.g., Carroll v. 

Macy’s, Inc., 2020 WL 3037067 at *3 (N.D. Ala. June 5, 2020); Aboltin v. Jeunesse, LLC, 2018 

WL 6576464, at *2 (M.D. Fla. Sept. 13, 2018) (granting preliminary approval of a Notice Plan 

providing for e-mail notice to all class members and postcard notice by U.S. mail if the defendant 

did not have an e-mail address for a certain class member or if two e-mail attempts proved

unsuccessful for a certain class member).

These proposed notice methods provide adequate notice to potential class members and 

explain, in sufficient detail, their individual rights under the settlement. Moreover, the claim forms 

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are reasonable. (Doc. # 3209). Therefore, the court finds that the proposed Notice Plan is 

appropriate in both form and content and is due to be approved. 

4. CAFA Notice

The court recognizes that the Class Action Fairness Act (“CAFA”), 28 U.S.C. § 1715, 

imposes additional notice requirements on defendants in class action lawsuits. In the Settlement 

Agreement, the Settling Defendants have agreed to serve or cause to be served a notice of the 

proposed settlement on appropriate federal and state officials in accordance with the requirements 

of CAFA, 28 U.S.C. § 1715(b), and notify the court that CAFA compliance has been 

accomplished.

V. Conclusion

There is a “strong judicial policy favoring settlement.” Ponzio v. Pinon, 87 F.4th 487, 494 

(11th Cir. 2023) (citing Bennett, 737 F.2d at 986 and In re U.S. Oil & Gas Litig., 967 F.2d 489, 

493 (11th Cir. 1992) (“Public policy strongly favors the pretrial settlement of class action 

lawsuits.”)). Having carefully considered Provider Plaintiffs’ Motion for Preliminary Approval of 

Proposed Class Settlement, the Settlement Agreement, Provider Plaintiffs’ Motion for Approval 

of a Plan for Notice and Appointment of Settlement Notice Administrator and Settlement 

Administrator, the Proposed Plan of Distribution, and the Proposed Notice Plan, as well as all 

related matters of record, the court finds that it is likely it will certify the class for settlement 

purposes at final approval and that there is good cause to preliminarily approve the proposed 

settlement, subject to further consideration by the court after notice to the class and a fairness 

hearing. The court concludes that the proposed Settlement Agreement appears sufficiently fair, 

reasonable, and adequate to warrant submitting the proposed settlement to the Settlement Class 

and setting a fairness hearing. It is therefore ORDERED as follows:

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1. The Settlement Agreement is sufficiently within the range of reasonableness such 

that preliminary approval should be granted. Thus, the terms of the Settlement Agreement, 

including the releases contained therein, are hereby PRELIMINARILY APPROVED as being 

fair, reasonable, and adequate to the Settlement Class, subject to the Final Fairness Hearing 

described below.

2. Pursuant to Rule 23 of the Federal Rules of Civil Procedure, Provider Plaintiffs 

have shown that the court will likely be able to certify the class defined in Provider Plaintiffs’ 

motion papers for purposes of the Settlement and Final Judgment. The court PRELIMINARILY 

CERTIFIES the following Settlement Class, for settlement purposes only: all Providers in the 

United States (other than Excluded Providers, who are not part of the Settlement Class) who 

currently provide or provided healthcare services, equipment or supplies to any patient who was 

insured by, or who was a Member of or a beneficiary of, any plan administered by any Settling 

Individual Blue Plan during the Settlement Class Period. The term “Excluded Providers” means:

(i) Providers owned or employed by any of the Settling Defendants; 

(ii) Providers owned or employed exclusively by Government Entities or 

Providers that exclusively provided services, equipment or supplies to 

members of or participants in Medicare, Medicaid or the Federal Employee 

Health Benefits Programs;

(iii) Providers that have otherwise fully released their Released Claims against 

the Releasees prior to the Execution Date, including but not limited to 

Providers that were members of any of the settlement classes in Love v. Blue 

Cross and Blue Shield Association, No. 1:03-cv-21296-FAM (S.D. Fla.); or 

(iv) Providers that exclusively provide or provided (a) prescription drugs; (b) 

durable medical equipment; (c) medical devices; (d) supplies or services 

provided in an independent clinical laboratory; or (e) services, equipment 

or supplies covered by standalone dental or vision insurance. 

Any Provider that falls within the exclusions set forth in clauses (i), (ii) or (iv) of this Paragraph 

for only a portion of the Settlement Class Period is a Settlement Class Member that may recover 

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in the settlement as set forth in the Plan of Distribution. The “Settlement Class Period” is July 24, 

2008, through the Execution Date of the Settlement Agreement, which is October 4, 2024.

3. Solely for purposes of the Settlement set forth in the Settlement Agreement, the 

court CONCLUDES that it is likely that the requirements of Federal Rule of Civil Procedure 23(a) 

and 23(b)(3) will be satisfied at the time of final approval, with likely findings as follows: 

(a) the members of the Settlement Class are so numerous that joinder of all Class 

Members in the Action is impracticable; 

(b) there are questions of law and fact common to the Settlement Class and these 

common questions predominate over any individual questions; 

(c) the claims of Class Representatives are typical of the claims of the Settlement 

Class; 

(d) Class Representatives and Settlement Class Counsel have fairly and adequately 

represented and protected the interests of the Settlement Class; and 

(e) a class action is superior to other available methods for the fair and efficient 

adjudication of the controversy, considering (i) the interests of the members of 

the Settlement Class in individually controlling the prosecution of separate 

actions; (ii) the extent and nature of any litigation concerning the controversy 

already begun by members of the Settlement Class; (iii) the desirability or 

undesirability of concentrating the litigation of these claims in this particular 

forum; and (iv) the likely difficulties in managing this Action as a class action.

4. If the Effective Date does not occur with respect to the Settlement Agreement 

because of the failure of a condition of the Settlement Agreement, this assessment of the likelihood 

of certification of the Settlement Classes SHALL be deemed null and void, and the Parties 

SHALL retain their rights to seek or to object to certification of this litigation as a class action 

under Rule 23 of the Federal Rules of Civil Procedure or under any other state or federal rule, 

statute, law or provision thereof, and to contest and appeal any grant or denial of certification in 

this litigation or in any other litigation on any other grounds.

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Class Counsel and Class Representatives

5. Pursuant to Rule 23(g) of the Federal Rules of Civil Procedure, and solely for 

settlement purposes, Edith M. Kallas and Joe R. Whatley, Jr. of Whatley Kallas LLP are 

PRELIMINARILY DESIGNATED as Provider Co-Lead Counsel.

6. The court PRELIMINARILY APPOINTS the following as class representatives: 

Jerry L. Conway, D.C.; InMed Group, Inc., f/k/a Crenshaw Community Hospital; Bullock County 

Hospital; Evergreen Medical Center, LLC; Jackson Medical Center; Ivy Creek Healthcare; Elmore 

Community Hospital; Georgiana Medical Center; Lake Martin Community Hospital; Joseph D. 

Ackerson, Ph.D.; Janine Nesin, P.T., D.P.T., O.C.S.; Roman Nation, M.D.; Neuromonitoring

Services of America, Inc.; Confluent Health; ProRehab, P.C.; Texas Physical Therapy Specialists, 

LLC; BreakThrough Physical Therapy, Inc.; Dunn Physical Therapy, Inc.; Gaspar Physical 

Therapy, P.C.; Timothy H. Hendlin, D.C.; Greater Brunswick Physical Therapy, P.A.; Charles 

Barnwell, D.C.; Judith Kanzic, D.C.; Brian Roadhouse, D.C.; Dr. Saket K. Ambasht, M.D.; 

Snowden Olwan Psychological Services; Matthew Caldwell, M.D.; and Mishanta Reyes, M.D.

Administration and CAFA Notice

7. BrownGreer PLC is APPOINTED as the Settlement Notice Administrator, with 

responsibility for the Notice Plan, and all other obligations of the Settlement Notice Administrator 

as set forth in the Settlement Agreement and the Notice Motion.

8. Special Master Ed Gentle is APPOINTED as the Settlement Administrator, with 

the responsibilities and obligations set forth in the Settlement Agreement and the Notice Motion.

9. In addition, Provider Plaintiffs SHALL move for appointment of, and the court will 

select, a Settlement Claims Administrator to assist in the implementation of the Plan of 

Distribution.

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10. The fees of the Settlement Notice Administrator, the Settlement Administrator, and 

the Settlement Claims Administrator, as well as all other costs and expenses associated with notice 

and administration, SHALL be paid directly from the Notice and Administration Fund.

11. Within thirty (30) calendar days of entry of this Order, Settling Defendants SHALL

cause the $100 million Notice and Administration Fund to be transferred into an Escrow Account. 

All Notice and Administration Costs are hereby authorized to be paid from the Notice and 

Administration Fund, subject to court approval.

12. The Settlement Claims Administrator MAY, as necessary, require claimants to 

provide, through written, electronic, or other means, certain information to verify the claimant’s 

status as a Settlement Class Member, eligibility for any benefits under the Settlement Agreement, 

and information that will allow the Settlement Claims Administrator to calculate the monetary 

amount to which the claimant is entitled, in addition to any other purposes consistent with the 

Settlement Claims Administrator’s responsibilities under the Settlement Agreement.

13. The Settling Defendants SHALL serve or cause to be served a notice of the 

proposed Settlement on appropriate federal and state officials in accordance with the requirements 

of CAFA, 28 U.S.C. § 1715(b). Once completed, Settling Defendants SHALL file with the court 

a status report certifying that they have proof of receipt of CAFA mailing to federal officials and 

officials of all U.S. states and territories.

Notice to the Class

14. The Notice Plan contemplated by the Settlement Agreement and set forth in the 

Notice Motion, including the forms of notice and Claim Form attached as exhibits to the 

supplement to the Notice Motion (Doc. # 3209), satisfy the requirements of Federal Rule of Civil 

Procedure 23 and due process and thus are APPROVED. Non-material modifications to the 

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exhibits may be made without further order of the court, including converting and conforming the 

exhibits to electronic or digital formats. Advertisements for the Settlement, including internet 

banner advertisements, may be created without further order of the court if they contain materially 

identical language to the forms of notice approved in this order. The Settlement Notice 

Administrator is DIRECTED to carry out the Notice Plan pursuant to the Settlement Agreement 

and to perform all other tasks that the Settlement Agreement requires of the Settlement Notice 

Administrator.

15. The Settlement Notice Administrator SHALL provide direct individual notice to 

members of the Settlement Class via email for whom an email address is available, and by postcard 

notice via USPS where an email address is unavailable, email notice proves undeliverable after 

two attempts, or the email address is identified as inactive or invalid.

Exclusions from the Class

16. Any Class Member who wishes to be excluded from the Settlement Class SHALL

mail a written notification of their intent to be excluded to the Settlement Notice Administrator at 

the address provided in the long-form notice, in the notices published in the media, and on the 

settlement website, postmarked no later than March 4, 2025. The exclusion request SHALL

include the following

a. The Class Member’s name;

b. The name of the authorized representative submitting the Exclusion 

Request, if the Class Member is not an individual;

c. The Class Member’s address, email address, and telephone number;

d. The address, email address, and telephone number of the authorized 

representative submitting the Exclusion Request, if the Class Member is not 

an individual;

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e. If the Class Member has assigned, transferred or otherwise given a financial 

interest in its claims against the Settling Defendants to a third party (in 

whole or in part), the name, address and telephone number of the third party;

f. All National Provider Identifiers (NPI), Tax Identification Numbers (TIN), 

and Medicare Provider Numbers (MPN) under which the Class Member 

billed for services between 2008 and 2024, and the last four digits of the 

Class Member’s Social Security Number, if applicable;

g. A statement that the Class Member (or its authorized representative) wishes 

to be excluded from the Settlement Class in In re: Blue Cross Blue Shield 

Antitrust Litigation; and 

h. The personal, physical signature of the Class Member or its authorized 

representative. Electronic signatures, including Docusign, or PDF 

signatures are not permitted and will not be considered personal signatures. 

Requests signed solely by the Class Member’s lawyer, unless employed by 

the Health Care System, Health Care Facility, Medical Group or Medical 

Organization seeking to be excluded from the Class, are not valid. Further, 

a Health Care System, Medical Group, or Medical Organization may not 

submit a single Exclusion Request on behalf of individuals who are Class 

Members, even if they are employees of the Health Care System, Medical 

Group, or Medical Organization. Each Class Member must submit his, her, 

or its own Exclusion Request and each Exclusion Request must be signed 

by the Class Member himself or herself or, in the case of a Health Care 

System, Health Care Facility, Medical Group or Medical Organization, by 

its duly authorized representative.

If the Class Member fails to provide all of the required information on or before the Opt-Out 

Deadline, then the attempt to opt out shall be invalid and have no legal effect, and the Settlement 

Class Member shall be bound by the Settlement Agreement, including the releases, if finally 

approved.

17. The Settlement Notice Administrator SHALL provide Provider Co-Lead Counsel 

and Settling Defendants’ counsel with electronic copies of all opt-out notifications promptly upon 

receipt. Settlement Class Counsel SHALL provide a final list of all who have timely and validly 

excluded themselves from the Settlement Classes in accordance with the terms of the Settlement 

Agreement, which SHALL be filed with the court before the Final Fairness Hearing.

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18. All Settlement Class Members who submit valid and timely notices of their intent 

to be excluded from the Settlement Class WILL NOT be entitled to receive any benefits from the 

Settlement, including entitlement to Injunctive Relief, and WILL NOT be bound by the terms of 

the Settlement Agreement. Any Settlement Class Member that does not timely and validly exclude 

himself or herself from the Settlement SHALL be bound by the terms of the Settlement Agreement 

and all proceedings, orders, and judgments in this matter, including but not limited to the releases 

set forth in the Settlement Agreement and any Final Judgment.

Objections to the Settlement

19. A Settlement Class Member who complies with the requirements of this Order may 

object to the Settlement Agreement or Settlement Class Counsel’s request for fees and expenses.

20. No Class Member will be heard, and no papers, briefs, pleadings, or other 

documents submitted by any Class Member will be received and considered by the court, unless 

the Class Member presents an objection that is mailed to the Settlement Notice Administrator, 

Provider Co-Lead Counsel, and Settling Defendants’ counsel at the addresses listed in the longform notice available on the Settlement website, and postmarked by no later than the objection 

deadline March 4, 2025. For the objection to be considered by the court, the objection SHALL

be in writing and SHALL set forth:

a. The name of this Action and a description of the objections, including 

applicable legal authority and any supporting evidence the objector wishes 

to introduce;

b. The objector’s name, address, email address, and telephone number, and the 

names of any Settling Defendants with which the object or had a contract 

with during the Class Period;

c. The National Provider Identifiers and/or Taxpayer Identification Numbers 

the objector used when submitting claims to the Blues for reimbursement 

(this information may be redacted in the objector’s submission to the 

Court);

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d. Whether the objection applies only to the objector, a specific subset of the 

Settlement Class, or the Settlement Class as a whole;

e. The identity of all counsel who represent the objector, including former or 

current counsel who may be entitled to compensation for any reason related 

to the objection, along with the number of times (within five years preceding 

the submission of the objection) that counsel has, on behalf of a client, 

objected to a class action, the caption of the case for each prior objection, 

and a copy of any relevant orders addressing the objection;

f. Any agreements that relate to the objection or the process of objecting 

between the objector, his or her counsel, and/or any other person or entity;

g. The objector’s (and the objector’s attorney’s) signature on the written 

objection;

h. A statement indicating whether the objector intends to appear at the Final 

Fairness Hearing (either personally or through counsel); and

i. A declaration under penalty of perjury that the information provided by the 

objector and objector’s counsel is true and correct.

Plan of Distribution and Claims Process

21. Settlement Class Counsel have submitted to the court for approval the Plan of 

Distribution for the Damages Class that provides for the distribution of the Net Settlement Fund 

and the foundation for the requested allocation. The Plan of Distribution is briefly described herein.

22. In summary, the Plan of Distribution establishes a process for assessing and 

determining the validity and value of claims and a methodology for paying Settlement Class 

Members that submit a timely, valid Claim Form. The Plan of Distribution allows claimants to 

request a share of the Net Settlement Fund based in part on their Allowed Amounts during the 

Settlement Class Period. A claimant’s share of the Net Settlement Fund will also depend on the 

geographic area where the Provider is located.

23. Settlement Class Members that qualify for and wish to submit a Claim Form 

SHALL do so in accordance with the requirements and procedures specified in the notices and the 

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Claim Form. If the Settlement Agreement is finally approved, any and all Settlement Class 

Members that fail to submit a claim in accordance with the requirements and procedures specified 

in the notices and Claim Form SHALL be forever barred from receiving any portion of the Net 

Settlement Fund, but will in all other respects be subject to and bound by the provisions of the 

Settlement Agreement, including the releases included in the Settlement Agreement and any Final 

Judgment. Settlement Class Members are not required to submit a Claim Form in order to receive 

entitlement to the injunctive relief included in the Settlement Agreement.

24. The court finds that the Proposed Plan of Distribution is within the range of 

reasonableness, fairness, and adequacy so that it may be sent to the members of the Settlement 

Classes, and it is hereby PRELIMINARILY APPROVED.

Final Fairness Hearing

25. A Final Fairness Hearing is hereby scheduled before the undersigned to be 

commenced on Tuesday, July 29, 2025 at 9:30 a.m., continuing on Wednesday, July 30, and 

on Thursday, July 31, 2025, if necessary, in Courtroom 8 of the Hugo L. Black United States 

Courthouse, 1729 5th Avenue North, Birmingham, Alabama. The date of the Final Fairness 

Hearing SHALL be set forth in the Notice to the Settlement Class, but shall be subject to 

adjournment by the court without further notice to the members of the Settlement Class other than 

that which may be posted at the court and on the settlement website. At or after the Final Fairness 

Hearing, the court will determine whether the Settlement Agreement and the Plan of Distribution 

should be finally approved.

Summary of Deadlines

26. The Settlement Agreement SHALL be administered according to its terms pending 

the Final Fairness Hearing. The court APPROVES the following timeline for the Notice Plan:

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12/04/2024 The Court grants preliminary approval

01/03/2025 The Settlement Notice Administrator completes Class Notice

02/02/2025 Deadline for Settlement Class Counsel to file Fee and Expense Application 

and move for appointment of Settlement Claims Administrator

03/04/2025 Deadline to opt out of or object to the Settlement

04/23/2025 Deadline for Settlement Class Counsel to file the Final Approval Motion

07/16/20259 Final Fairness Hearing and claim filing deadline

Other Provisions

27. In the event the Settlement Agreement does not become final, or is otherwise 

rescinded or terminated, the Settlement Agreement SHALL be of no force or effect and any and 

all parts of the Settlement Fund caused to be deposited in the Escrow Account (other than Notice 

and Administration Costs reasonably and actually incurred up to the date of rescission or 

termination), along with any income accrued thereon, SHALL be returned to the entities that paid 

such amounts into the Escrow Account, in proportion to those entities’ respective contributions to 

the Settlement Fund within ten (10) calendar days of rescission, termination, or a court’s final 

determination denying final approval of the Agreement and/or certification of the Settlement Class, 

whichever occurs first.

28. In the event the Settlement Agreement does not become final, or is otherwise 

rescinded or terminated, litigation of the Provider Actions against Settling Defendants SHALL 

resume in a reasonable manner to be approved by the court upon application by the Parties. The 

Parties expressly reserve all of their rights if this Agreement is rescinded or does not otherwise 

become final.

DONE and ORDERED this December 4, 2024.

_________________________________

R. DAVID PROCTOR

CHIEF U.S. DISTRICT JUDGE

9 This date can be set at the Court’s convenience, but the Parties have agreed that it will not be earlier than 

90 business days after the Opt-Out Deadline.

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