Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-2_13-cv-20000/USCOURTS-alnd-2_13-cv-20000-3/pdf.json

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

---

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 document relates to both tracks. 

)

)

MEMORANDUM OPINION

I. Introduction

This case is before the court on five Motions to Dismiss (e.g., Docs. # 208, 210, 211, 212,

213, Case No. 2:12-cv-02169-RDP) that have been filed by nine of the thirty-eight Defendant 

Blue Plans1 (collectively referred to as “Moving Defendants”). In their motions, these nine 

Defendants contest personal jurisdiction over them with respect to the actions filed in the 

Northern District of Alabama (“Northern District”) and contend venue is improper in the 

Northern District for these actions.

2

 The other twenty-nine Blues have not challenged personal 

jurisdiction or venue. The motions are fully briefed. (See, e.g., Docs. # 209-13, 218, 220-22,

227, Case No. 2:12-cv-02169-RDP; Docs. # 369, 374-77, Case No. 2:12-cv-02532-RDP). After 

careful review, and with the benefit of oral argument from the parties, the court concludes that 

Moving Defendants’ motions to dismiss are due to be denied.

 1 The Moving Defendants are (1) Blue Cross & Blue Shield of Mississippi, (2) Triple-S Salud, Inc., (3) 

Blue Cross Blue Shield of Arizona, (4) Blue Cross and Blue Shield of Kansas, Inc., (5) Noridian Mutual Insurance 

Company, d/b/a Blue Cross Blue Shield of North Dakota, (6) Blue Cross Blue Shield of Wyoming, (7) HealthNow 

New York, Inc., d/b/a BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, (8) 

Excellus Health Plan, Inc., d/b/a Excellus BlueCross BlueShield, and (9) Capital BlueCross.

2

 Motions to dismiss have been filed in the following actions: (1) Conway, et al., v. Blue Cross & Blue 

Shield of Alabama, et al., Case No. 2:12-cv-02169-RDP (N.D. Ala.); (2) American Electric Motor Services, Inc., et 

al., v. Blue Cross Blue Shield of Alabama, et al., Case No. 2:12-cv-02532-RDP (N.D. Ala.); (3) Pettus Plumbing & 

Piping, Inc. v. Blue Cross Blue Shield of Alabama, et al., Case No. 3:16-cv-00297-RDP (N.D. Ala.); and (4) Pearce, 

Bevill, Leesburg, Moore, P.C. v. Blue Cross Blue Shield of Alabama, et al., Case No. 2:16-cv-00464-RDP (N.D. 

Ala.).

FILED

 2016 Dec-21 PM 04:39

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 1 of 63
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II. Relevant Factual Allegations from Provider Plaintiffs’ and Subscriber Plaintiffs’ 

Master Complaints

In their operative complaint, Provider Plaintiffs assert several grounds for the court’s 

personal jurisdiction over Defendants. (Doc. # 236 at ¶¶ 12-13, Case No. 2:13-cv-20000-RDP). 

First, they claim that Defendants are subject to the court’s personal jurisdiction under Section 12 

of the Clayton Act because they “transact business in this [d]istrict.” (Id. at ¶ 13). Second, they 

contend that the court may exercise personal jurisdiction over Defendants under the conspiracy 

theory of jurisdiction because (1) Defendants have participated in a conspiracy, and (2) at least 

one co-conspirator, Blue Cross and Blue Shield of Alabama (“BCBS-AL”), has committed overt 

acts in furtherance of the conspiracy within Alabama. (Id. at ¶¶ 12-13). Third, they claim that 

all Defendants have maintained minimum contacts with Alabama by paying health care entities 

and individuals that provide services within Alabama. (Id. at ¶ 13). 

In their consolidated complaint, Provider Plaintiffs allege that Defendants have violated 

various federal and state competition laws, including the Sherman Act, by agreeing to allocate 

geographic service areas between Blue Cross and Blue Shield entities (or plans) (“Blue Plans”), 

fix prices for certain products and services available from health care providers, and boycott all

health care providers who reside outside of a Blue Plan’s allocated geographic service area. 

(See, e.g., id. at ¶¶ 4, 169, 229). Specifically, they allege that in September 1982 the Board of 

Directors for the Blue Cross Blue Shield Association3 (“BCBSA” or “Association”) adopted a 

Long Term Business Strategy, through which “Defendants agreed not to compete with each 

other.” (Id. at ¶ 187). The Blue Plans agreed to “centralize the ownership of their trademarks 

 3

 BCBSA is an Illinois corporation that has its headquarters in Illinois. (Doc. # 236 at ¶ 133, Case No. 

2:13-cv-20000-RDP). 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 2 of 63
3

and trade names” and to ensure that by the end of 1985 “each state would only have one Blue 

[Plan].” (Id. at ¶¶ 188-89). 

According to Provider Plaintiffs, all of the Blue Plan Defendants (including Moving 

Defendants) held a series of meetings in 1987, during which they agreed to sell insurance under 

the Blue Cross and Blue Shield trademarks in exclusive geographic service areas. (Id. at ¶ 190). 

Thereafter, each Blue Plan entered into Blue Cross License Agreements and Blue Shield License 

Agreements (collectively referred to as “License Agreements”) with the Association. (Id. at ¶ 

192). These License Agreements prevent a Blue Plan or its subsidiaries from competing under 

the Blue Cross and Blue Shield trademarks outside of a designated geographic service area. (Id.

at ¶ 196). Moreover, the License Agreements dictate that the entity owning a Blue Plan for a 

certain geographic service area must obtain at least 80 percent of its annual revenue generated 

within that designated service area from services offered under the Blue Cross and Blue Shield 

trademarks. (Id. at ¶ 197).

Additionally, the License Agreements mandate that Blue Plans participate in various 

BCBSA national programs, including the BlueCard Program and the National Accounts 

Program. (Id. at ¶ 229). Pursuant to the National Accounts Program, Blue Plans agree, with 

limited exceptions, not to solicit services from or contract with health care providers outside of 

their designated geographic service areas. (Id. at ¶ 230). If a Blue Plan’s member requires

health care services while he or she is outside of the Blue Plan’s geographic service area, the 

BlueCard Program allows that member to receive health care services from a provider who has a 

contract with the Blue Plan that controls that geographic service area. (See id. at ¶ 231). When a 

health care provider serves a member of a Blue Plan from another geographic service area, the 

provider submits a claim to the Blue Plan within that geographic service area (called the Host 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 3 of 63
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Plan). (Id. at ¶ 236). The Host Plan “prices [the claim] according to contracted provider 

agreements, then sends an electronic submission” to the member’s out-of-area Blue Plan (called 

the Home Plan). (Id.). The Home Plan reviews the submitted claim from the Host Plan and 

sends a disposition to the Host Plan, which is responsible for reimbursing the health care 

provider. (Id.).

Provider Plaintiffs allege that BCBS-AL is the thirteenth largest health insurer in the 

nation and that it would likely offer health care financing in regions other than the state of 

Alabama but for the territorial restrictions in the License Agreements.4 (Id. at ¶ 141). According 

to Provider Plaintiffs, BCBS-AL has market power throughout Alabama in the health care 

financing market, with an 86 percent market share in the entire state. (Id. at ¶ 259). They claim 

that BCBS-AL’s reimbursement rates for primary care physicians are so low that many primary 

care physicians retire because it is not worthwhile for them to continue practicing medicine. (Id.

at ¶ 326). Moreover, BCBS-AL prohibits providers from offering similar price terms to other 

health care insurers. (Id. at ¶ 340). Accordingly, “competition in the state of Alabama has been 

and continues to be harmed in that the other 36 Blue[ ] [Plans] agree not to enter the Alabama 

market to complete with Blue Cross Blue Shield of Alabama[,] no matter the circumstances.” 

(Id. at ¶ 346).

Plaintiffs allege that, on at least one occasion, BCBS-AL enforced this price fixing 

conspiracy against an Alabama hospital when the hospital billed a higher rate to another Blue 

Plan. According to Provider Plaintiffs’ complaint:

[W]hen a hospital in east Alabama billed other Defendant Blues directly for their 

subscribers, those Blues, including Blue Cross of Minnesota[,] paid for those 

services at the rates that it normally pays, which are higher than the rates paid by 

Blue Cross of Alabama. When Blue Cross of Alabama learned of those 

 4

 BCBS-AL’s headquarters are located in Birmingham, which is in the Northern District. (Doc. # 236 at ¶

61, Case No. 2:13-cv-20000-RDP).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 4 of 63
5

payments, it then recouped the difference between those higher rates and the Blue 

Cross of Alabama rates from payments due for services for Blue Cross of 

Alabama subscribers. Based on information and belief, Plaintiffs allege that Blue 

Cross of Alabama and the other Blues divided the funds recouped under the 

procedures established by the Defendant Blues.

(Id. at ¶ 234). 

In their operative complaint, Subscriber Plaintiffs point to several grounds upon which 

this court may assert personal jurisdiction over Defendants. First, Subscriber Plaintiffs rely on 

Section 12 of the Clayton Act. (Doc. # 244 at ¶ 12A, Case No. 2:13-cv-20000-RDP). Second, 

they rely on the conspiracy theory of personal jurisdiction because Defendants participated in a 

conspiracy that injured subscribers in Alabama, and overt acts were committed to further the 

conspiracy in Alabama. (See id. at ¶ 12A(a)). Third, they contend that Defendants have

maintained minimum contacts with Alabama because Defendants have either (1) committed 

intentional acts that were intended to cause harm in Alabama and actually caused harm in 

Alabama, or (2) committed intentional acts that they knew were likely to cause injury within 

Alabama. (See id. at ¶ 12A(b)-(c)). Fourth, they allege that Defendants have maintained 

minimum contacts with Alabama because they have members in Alabama or they transact 

business within Alabama. (See id. at ¶ 12A(f)).

With regard to the conspiracies alleged in these cases, Subscriber Plaintiffs contend that 

in 1982 the Association became the sole owner of the Blue Cross and Blue Shield trademarks 

after the Blue Cross Association and the Blue Shield Association merged.5

 (Id. at ¶ 324). 

According to Subscriber Plaintiffs, BCBSA is actually controlled by the Blue Plans, and its rules 

and regulations are actually horizontal agreements between the Blue Plans. (Id. at ¶ 344). 

Through the License Agreements, membership guidelines, and membership standards, the Blue 

 5

 In the 1950s, the Blue Plans transferred their rights to the Blue Cross and Blue Shield trademarks to 

centralized entities. (Id. at ¶¶ 321-22). 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 5 of 63
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Plans have conspired with each other “to divide the geographic market for health insurance.” 

(Id. at ¶¶ 350-51). Defendants’ agreement to allocate geographic markets has resulted in the 

following harms to the residents of Alabama: (1) a reduction of health insurance companies 

competing with BCBS-AL for business; (2) unreasonable limitations on entering the Alabama

health insurance market; (3) the maintenance and enlargement of BCBS-AL’s market power; (4) 

supra-competitive premiums; and (5) the deprivation of “benefits of free and open competition,” 

including the deprivation of access to a market whose prices have been established in the 

absence of non-price restraints on competition. (Id. at ¶¶ 571, 573). 

In addition, Provider Plaintiffs allege that BCBS-AL is licensed to use the Blue Cross and 

Blue Shield trademarks and has agreed to conduct business under those brands only in 

Alabama.

6

 (Id. at ¶ 415). They claim that BCBS-AL has at least a 90 percent market share in 

the individual health insurance market and at least a 97 percent market share in the small group 

health insurance market. (Id.). Moreover, they assert that BCBS-AL has used its market power 

to charge supra-competitive premiums to individuals and small groups that purchased health 

insurance. (Id. at ¶ 418). For example, it increased individual premiums by more than 17 

percent in 2010. (Id. at ¶ 419). 

Provider Plaintiffs also contend that venue is proper in this court for two reasons. First, 

venue is proper under Section 12 of the Clayton Act because Defendants “transact business” in 

the Northern District of Alabama. (Doc. # 236 at ¶ 14, Case No. 2:13-cv-20000-RDP). Second, 

 6

 The court notes that Plaintiffs have not stated where BCBS-AL agreed to the License Agreements, 

membership standards, or membership guidelines. (See, e.g., Doc. # 244 at ¶¶ 565-69, Case No. 2:13-cv-20000-

RDP). At oral argument, counsel for five of the Moving Defendants informed the court that the License Agreements 

are governed by Illinois law. (Doc. # 905 at 144, Case No. 2:13-cv-20000-RDP).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 6 of 63
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venue is proper under 28 U.S.C. § 1391 because a significant part of the events, acts, and 

omissions resulting in this action occurred in the Northern District.7 (Id.).

III. Record Evidence Concerning Personal Jurisdiction and Venue

A. Common Jurisdictional Facts

Through their submitted affidavits, Moving Defendants have presented the following

common evidence regarding particular contacts they lack with the state of Alabama. First, none 

of the Moving Defendants are registered in Alabama or licensed to do business in Alabama.8 

Second, none maintain an office in Alabama or the Northern District.9 Third, none have an 

employee based in Alabama.10 Fourth, none direct marketing activities towards potential 

 7

 Similarly, Subscriber Plaintiffs also rely on Section 12 of the Clayton Act and 28 U.S.C. § 1391 to 

demonstrate that venue is proper in this district. (Doc. # 244 at ¶ 14, Case No. 2:13-cv-20000-RDP). Theyclaim in 

their complaint that venue is proper in this district under Sections 4 and 16 of the Clayton Act. (See id.). But the 

court has not considered these proposed alternative grounds for venue because Subscriber Plaintiffs have proffered 

no argument in support of them in their response to Moving Defendants’ motions. (See generally Doc. # 369, Case 

No. 2:12-cv-02532-RDP).

8

 (See, e.g., Doc. # 122, Ex. A at 1, Case No. 2:13-cv-20000-RDP; Doc. # 210, Ex. 1 at 1, Case No. 2:12-

cv-02169-RDP (stating that Triple-S Salud is licensed to conduct business in Puerto Rico and the U.S. Virgin 

Islands); Doc. # 211 Ex. 1 at 1, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 2 at 1, Case No. 2:12-cv-02169-

RDP; Doc. # 211, Ex. 3 at 1, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP; 

Doc. # 211, Ex. 5 at 1, Case No. 2:12-cv-02169-RDP; Doc. # 212, Ex. G at 1-2, Case No. 2:12-cv-02169-RDP; Doc. 

# 213, Ex. 1 at 3, Case No. 2:12-cv-02169-RDP).

9 (See, e.g., Doc. # 122, Ex. A at 1, Case No. 2:13-cv-20000-RDP; Doc. # 210, Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP; Doc. # 211 Ex. 1 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv02169-RDP; Doc. # 211, Ex. 3 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-

RDP; Doc. # 211, Ex. 5 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 212, Ex. C, Case No. 2:12-cv-02169-RDP; Doc. 

# 213, Ex. 1 at 3, Case No. 2:12-cv-02169-RDP).

10 (See, e.g., Doc. # 122, Ex. A at 1, Case No. 2:13-cv-20000-RDP; Doc. # 210, Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP (asserting that Triple-S Salud has no employees or agents in any of the fifty states); Doc. # 211 Ex. 1 

at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 3 at 2, 

Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 5 at 2, Case 

No. 2:12-cv-02169-RDP; Doc. # 212, Ex. C, Case No. 2:12-cv-02169-RDP; Doc. # 213, Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 7 of 63
8

insurance customers in Alabama, solicit business from individual residents of Alabama, or solicit 

business from companies headquartered in Alabama.11 

Eight of the nine Moving Defendants own no real property in the state of Alabama.12 

Likewise, eight of the nine Moving Defendants have no telephone number or mailing address in 

Alabama.13 Moreover, eight of the nine Moving Defendants do not maintain a bank account in 

Alabama.14 Finally, seven of the nine Moving Defendants have stated that they do not issue 

insurance policies or contracts in Alabama.15

 11 (See, e.g., Doc. # 122, Ex. A at 2, Case No. 2:13-cv-20000-RDP; Doc. # 210, Ex. 1 at 2, Case No. 2:12-

cv-02169-RDP (stating that Triple-S Salud conducts no marketing or advertising in the fifty states); Doc. # 211 Ex. 

1 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 3 at 2, 

Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 5 at 2, Case 

No. 2:12-cv-02169-RDP; Doc. # 212, Ex. F, Case No. 2:12-cv-02169-RDP; Doc. # 213, Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP).

12 (See, e.g., Doc. # 122, Ex. A at 2, Case No. 2:13-cv-20000-RDP; Doc. # 210, Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 3 at 2, Case No. 2:12-cv02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 5 at 2, Case No. 2:12-cv-02169-

RDP; Doc. # 212, Ex. B, Case No. 2:12-cv-02169-RDP; Doc. # 213, Ex. 1 at 3, Case No. 2:12-cv-02169-RDP). 

Blue Cross Blue Shield of Arizona “has owned an interest in three real estate funds that collectively owned two 

properties in Alabama.” (Doc. # 211, Ex. 1 at 2, Case No. 2:12-cv-02169-RDP). 

13 (See, e.g., Doc. # 122, Ex. A at 2, Case No. 2:13-cv-20000-RDP; Doc. # 210, Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP; Doc. # 211 Ex. 1 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv02169-RDP; Doc. # 211, Ex. 3 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-

RDP; Doc. # 211, Ex. 5 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 212, Ex. C, Case No. 2:12-cv-02169-RDP). 

Capital BlueCross has not stated whether it maintains a telephone number or mailing address in Alabama. (See 

generally Doc. # 213, Ex. 1, Case No. 2:12-cv-02169-RDP).

14 (See, e.g., Doc. # 122, Ex. A at 2, Case No. 2:13-cv-20000-RDP; Doc. # 211 Ex. 1 at 2, Case No. 2:12-

cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 3 at 2, Case No. 2:12-cv02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 5 at 2, Case No. 2:12-cv-02169-

RDP; Doc. # 212, Ex. D, Case No. 2:12-cv-02169-RDP; Doc. # 213, Ex. 1 at 3, Case No. 2:12-cv-02169-RDP). 

Triple-S Salud has not asserted whether it has opened or maintained a bank account in Alabama. (See generally, 

Doc. # 210, Ex. 1, Case No. 2:12-cv-02169-RDP).

15 (See, e.g., Doc. # 210, Ex. 1 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211 Ex. 1 at 3, Case No. 2:12-

cv-02169-RDP; Doc. # 211, Ex. 2 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 3 at 2, Case No. 2:12-cv02169-RDP; Doc. # 211, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP; Doc. # 211, Ex. 5 at 2, Case No. 2:12-cv-02169-

RDP; Doc. # 213, Ex. 1 at 2, Case No. 2:12-cv-02169-RDP (averring that all of Capital BlueCross’s insurance 

policies are issued in Pennsylvania)). Blue Cross & Blue Shield of Mississippi and Excellus BlueCross BlueShield 

do not directly address in their affidavits whether they issue insurance policies in Alabama, but both have stated that 

they are not licensed to sell insurance in Alabama.

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B. Blue Cross & Blue Shield of Mississippi (“BCBS-MS”)16

According to a vice president for BCBS-MS, it is a Mississippi corporation whose 

principal place of business is in Mississippi. (Doc. # 122, Ex. A at 1, Case No. 2:13-cv-20000-

RDP). As of December 31, 2012, 4,198 BCBS-MS members resided in Alabama and 1,840 

BCBS-MS members resided in the Northern District in particular as of that date. (Doc. # 177, 

Ex. A at 2, Case No. 2:13-cv-20000-RDP). Approximately 8,000 BCBS-MS members “received 

covered services through the BlueCard program from providers located in the state of Alabama 

in 2012.” (Id.). Of the BCBS-MS members who received covered services in Alabama, 3,740 of 

them received those services from providers located in the Northern District. (Id.). Accordingly, 

less than one percent of BCBS-MS’s membership resided in the Northern District in 2012, and 

less than one percent of its members received health care services from providers in the Northern 

District. (See id.). BCBS-MS does not pay income taxes or property taxes in Alabama. (Doc. # 

122, Ex. A at 2, Case No. 2:13-cv-20000-RDP).

BCBS-MS has entered into contracts with nine physicians who reside in the Northern 

District. (Doc. # 256, Ex. 1 at 1, Case No. 2:13-cv-20000-RDP). BCBS-MS did not solicit the 

physicians’ services; rather, it received unsolicited applications from the physicians who sought

to join BCBS-MS’s provider network. (Id. at 2). BCBS-MS allowed these physicians to join its 

provider network because they operated in a county (in Alabama) that is contiguous to the state 

of Mississippi. (Id.). BCBS-MS’s corporate representative testified that these providers 

conducted their “primary business” within Mississippi but have physical offices in a contiguous 

county to the state of Mississippi. (Doc. # 371, Ex. 37 at 71, Case No. 2:12-cv-02532-RDP).

 16 This opinion discusses the individual Moving Defendants in descending order by number of members in 

Alabama.

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BCBS-MS offers health insurance to employers with employees who reside outside the 

state of Mississippi. (Id. at 21). If an employer has employees in other states, including 

Alabama, BCBS-MS is aware of that fact when it agrees to provide health insurance products to 

the employer. (Id. at 25). It acts as a host plan for employees who work for employers based in 

Alabama. (Id. at 39-40). It can determine a subscriber’s location of residence through 

enrollment information provided by an employer, an initial enrollment form completed by an

individual purchasing an insurance plan, or an individual’s address change in the electronic 

“membership portal.” (Id. at 49-50). It does not issue health insurance to individual applicants 

who do not reside in Mississippi when they apply. (Id. at 50).

From 2008 to 2013, an average of 4,186 subscribers and 7,463 members of BCBS-MS 

resided in the state of Alabama each year. (See Doc. # 218, Ex. 22, Case No. 2:12-cv-02169-

RDP (averaging the subscribers and members provided for each calendar year in the chart)). 

During those years, BCBS-MS received an average of $369,148.83 in premiums per year from 

Alabama subscribers. (See id.). Health care providers in Alabama submitted an average of 

42,077 BlueCard claims to BCBS-MS per year, and BCBS-MS paid an average of $7,369,179.41 

per year to settle those claims. (See id.). Moreover, from 2008 to 2013, an average of 1,894 

BCBS-MS subscribers and 3,202 BCBS-MS members resided in the Northern District, and 

BCBS-MS received an average of $189,286.80 per year in premiums from subscribers in the 

Northern District. (See id.). Health care providers in the Northern District submitted an average 

of 18,651 BlueCard claims per year to BCBS-MS, and BCBS-MS paid an average of 

$2,710,749.23 to settle those claims. (See id.). 

BCBS-MS owns a subsidiary, Bluebonnet Life Insurance Company, that conducts 

business in Alabama and is licensed to sell life insurance in Alabama. (Doc. # 371, Ex. 37 at 67-

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 10 of 63
11

68, Case No. 2:12-cv-02532-RDP). Currently, Bluebonnet Life Insurance Company does not 

actively sell or market life insurance to groups or individuals residing outside of Mississippi. 

(Id. at 68-69).

C. HealthNow New York, Inc., d/b/a BlueCross BlueShield of Western New 

York and BlueShield of Northeastern New York (“HealthNow”)

HealthNow is a nonprofit corporation that is incorporated in New York and has its 

principal place of business in New York. (Doc. # 211, Ex. 4 at 1, Case No. 2:12-cv-02169-

RDP). HealthNow’s manager of national accounts has averred that, from 2013 to June 2016, 

HealthNow did not file tax returns or pay taxes in Alabama. (Id. at 2). From 2013 to 2016, an 

average of 2,084 HealthNow members resided in Alabama per year, and an average of 1,027 of 

those members resided in the Northern District. (Id. at 3). According to HealthNow’s affidavit, 

approximately 0.4 percent of its members resided in Alabama during those years, and 

approximately 0.2 percent resided in the Northern District. (See id.). On average, during a four 

year period referenced in HealthNow’s supplemental affidavit, it received $2,850,465 per year in 

premiums from its members in Alabama and an average of $902,248 per year in premiums from 

its members in the Northern District. (Doc. # 220, Ex. 4 at 2, Case No. 2:12-cv-02169-RDP). 

From 2012 to 2015, an average of 2,254 HealthNow members each year received health 

care services in Alabama through the BlueCard Program. (Doc. # 211, Ex. 4 at 3, Case No. 2:12-

cv-02169-RDP). An average of 1,741 members each year received health care services in the

Northern District. (Id.). Thus, less than one percent of HealthNow’s total membership received 

health care services in Alabama or the Northern District. (See id. at 4). To settle providers’ 

BlueCard claims, HealthNow paid an average of $4,333,427 per year to providers in Alabama, of 

which an average of $2,707,830 per year was paid to providers in the Northern District. (Doc. # 

220, Ex. 3 at 3, Case No. 2:12-cv-02169-RDP).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 11 of 63
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D. Capital BlueCross (“Capital”)

Capital “is a Pennsylvania hospital plan corporation.” (Doc. # 213, Ex. 1 at 1, Case No. 

2:12-cv-02169-RDP). According to a Capital paralegal, Capital only issues individual health 

insurance plans for individuals who reside in 21 counties within Pennsylvania and group health 

insurance plans for employers who are headquartered or have a “corporate presence within 

Capital’s 21-county service area.” (Id. at 2). Capital’s insurance policies are issued in 

Pennsylvania, governed by Pennsylvania law, and contain forum selection clauses that require

disputes to be handled by courts located in Dauphin County, Pennsylvania. (Id. at 2-3). Capital

does not contract with medical providers in Alabama. (Id. at 3). 

As of April 2015, Capital has 245 subscribers and 587 members who reside in Alabama. 

(Id.). Of those subscribers and members, 148 subscribers and 386 members reside in the 

Northern District. (Id. at 3-4). According to Capital, “approximately 0.080% of [its] members” 

reside in the state of Alabama, and “approximately 0.053%” of its members reside in the 

Northern District. (Id. at 4). 

Capital’s affiant has asserted that it “derives no revenue from its activities” in Alabama. 

(Id. at 3). In 2012, it paid $2,074,988.83 to settle BlueCard claims arising from health care 

services provided in Alabama. (Id. at 4). During the first eight months of 2013, Capital received 

8,888 claims from Alabama-based providers of health care services and paid $2,375,717.59 to 

settle those claims. (See Doc. # 218, Ex. 24, Case No. 2:12-cv-02169-RDP). Of those claims, 

6,645 claims came from providers based in the Northern District, for which Capital paid 

$2,061,697.57. (See id.). During those eight months, Capital obtained approximately 

$720,859.26 in premiums and $149,405.57 in administrative fees from subscribers residing in 

Alabama. (Id. at 2).

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13

Capital offers group insurance plans to employers with employees who reside outside of 

Capital’s geographic service area. (Doc. # 218, Ex. 6 at 27-28, Case No. 2:12-cv-02169-RDP). 

According to Capital’s corporate representative, Capital is aware that some of its subscribers live 

and work outside of its geographic service area. (Id. at 33). Having said that, if an insurance 

group has between one and one hundred members, Capital requires that at least twenty-five

percent of the employer’s enrolling subscribers reside within Capital’s geographic service area. 

(Id. at 34-35). For small and midsize group plans, Capital is aware of where subscribing 

employees reside before it issues insurance coverage because enrollment applications must 

include an employee’s residential address. (Id. at 42-43). For large group plans, Capital is aware 

of the subscribers’ residential locations at the time that the group plan is formed because the 

employees’ residential addresses are submitted in order for Capital to produce an “experiencerated” quote. (Id. at 44).

E. Blue Cross Blue Shield of Arizona (“BCBS-AZ”)

BCBS-AZ is an Arizona corporation whose principal place of business is in Arizona. 

(Doc. # 211, Ex. 1 at 1, Case No. 2:12-cv-02169-RDP). According to BCBS-AZ’s corporate 

ombudsman, from 2013 to 2015, an average of 474 BCBS-AZ members resided in Alabama each 

year; of those members, an average of 266 resided in the Northern District. (Id. at 3). 

Additionally, from 2012 to 2016, an average of 530 BCBS-AZ members received health care

services in Alabama per year, and an average of 411 of those members received medical services 

in the Northern District. (Id.). From 2012 to 2015, BCBS-AZ collected an average of $427,064 

per year in premiums from its subscribers in Alabama, including an average of $234,976 per year 

in premiums from subscribers in this district. (Doc. # 220, Ex. 1 at 2, Case No. 2:12-cv-02169-

RDP). From 2013 to 2015, BCBS-AZ paid an average of $1,967,555 per year to settle claims 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 13 of 63
14

submitted by Alabama providers through the BlueCard Program. (Id. at 2-3). And BCBS-AZ 

paid an average of $1,550,888 per year to providers in the Northern District.17 (Id.).

A corporate representative for BCBS-AZ acknowledged that it is able to provide health 

insurance to employees who reside outside of Arizona if their employer is based in Arizona, 

unless the employee resides in Washington or Mississippi. (Doc. # 218, Ex. 7 at 21-22, Case No. 

2:12-cv-02169-RDP). BCBS-AZ cannot “transact insurance” in Washington or Mississippi due 

to license requirements in those states. (Id. at 22). When an employer seeks to purchase health 

insurance from BCBS-AZ, BCBS-AZ requests that the employer provide residency information 

about its employees so that it can produce an accurate quote. (Id. at 40-41). BCBS-AZ stores 

residency information about its subscribers in a database. (Id. at 41). 

F. Noridian Mutual Insurance Company, d/b/a/ Blue Cross Blue Shield of 

North Dakota (“BCBS-ND”)

BCBS-ND is a North Dakota company whose principal place of business is in North 

Dakota. (Doc. # 211, Ex. 5 at 1, Case No. 2:12-cv-02169-RDP). According to a vice president’s 

affidavit, BCBS-ND has not entered into a contractual relationship with a health care provider in 

Alabama. (Id. at 2). It has not filed tax returns or paid taxes in Alabama. (Id.). 

From 2013 to 2016, an average of 364 BCBS-ND members resided in Alabama each 

year. (Id. at 3). Of these members, an average of 306 resided in the Northern District. (Id.). 

From 2012 to 2015, BCBS-ND collected an average of $748,299 per year in premiums from its 

members in Alabama. (Doc. # 220, Ex. 5 at 2, Case No. 2:12-cv-02169-RDP). Its members in 

the Northern District paid an average of $599,361 per year in premiums. (Id.).

Moreover, from 2012 to 2015, an average of 760 BCBS-ND members received health 

care services from Alabama providers through the BlueCard Program each year. (Doc. # 211, 

 17 The court has not included BCBS-AZ’s BlueCard payments to providers in 2012 in its yearly average of 

payments because BCBS-AZ has only provided payment data for the final seven months of 2012.

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 14 of 63
15

Ex. 5 at 3, Case No. 2:12-cv-02169-RDP). Of these members, on average, 656 received health 

care services in the Northern District. (Id.). 

BCBS-ND’s corporate representative testified that the company requests the addresses 

for subscribers if it is producing a quote for a group. (Doc. # 218, Ex. 15 at 22, Case No. 2:12-

cv-2169-RDP). Therefore, it sometimes knows the residential address of an out-of-state 

subscriber before issuing insurance coverage to the subscriber. (Id.). For large employers, it 

might obtain the residential address of potential subscribers “through a census” of the employer. 

(Id. at 23). However, for small employers, “it’s pretty well understood where [the employees] 

live.” (Id.).

G. Blue Cross Blue Shield of Kansas (“BCBS-KS”)

BCBS-KS is a Kansas corporation whose principal place of business is in Kansas. (Doc. 

# 211, Ex. 2 at 1, Case No. 2:12-cv-02169-RDP). From 2013 to 2016, an average of 149 BCBSKS members resided in Alabama. (Id. at 3). Unlike the other Moving Defendants, BCBS-KS 

has averred that it cannot calculate the monetary amount of premiums that it has received from 

its members in Alabama or its members in the Northern District because the company collects

lump-sum premium payments from its group subscribers. (Doc. # 220, Ex. 2 at 2, Case No. 

2:12-cv-02169-RDP). 

From 2012 to 2015, an average of 369 BCBS-KS members received health care services 

each year in Alabama through the BlueCard Program. (Doc. # 211, Ex. 2 at 3, Case No. 2:12-cv02169-RDP). Of these members, approximately 321 each year received health care services in 

the Northern District. (Id.). During those years, BCBS-KS paid an average of $654,261 per year 

to settle BlueCard claims from health care providers located in Alabama. (Doc. # 220, Ex. 2 at 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 15 of 63
16

2, Case No. 2:12-cv-02169-RDP). And it paid approximately $553,266 per year for claims from 

providers located in this district. (Id.).

BCBS-KS’s corporate representative confirmed that it receives census forms from 

employers seeking to insure more than 50 employees. (Doc. # 218, Ex. 4 at 39, Case No. 2:12-

cv-02169-RDP). Its census forms require the employer to provide a residential address for each 

employee. (Id.).

H. Excellus BlueCross BlueShield (“Excellus”)

Excellus is a New York corporation whose principal place of business is in New York. 

(Doc. # 212, Ex. G at 1, Case No. 2:12-cv-02169-RDP). According to Excellus’s vice president 

of sales, at the end of 2013, Excellus had 137 subscribers in the Northern District. (Doc. # 212, 

Ex. H, Case No. 2:12-cv-02169-RDP). In 2013, Excellus obtained approximately $109,000 in 

premiums from its subscribers in the Northern District.18 Excellus’s vice president of claims has 

averred that it paid $949,429.95 to providers in the Northern District for claims submitted in 

2013. (Id., Ex. I). And Excellus’s counsel has also averred that the 2013 data from Excellus 

fairly represents its contacts with the Northern District. (Doc. # 369, Ex. 27 at 1, Case No. 2:12-

cv-02532-RDP (“Excellus . . . has no reason to believe that 2013 is not representative of the 

several years prior or since[.]”). According to Excellus’s director of contract negotiations, it 

currently has no contracts with health care providers in Alabama. (Doc. # 212, Ex. E, Case No. 

2:12-cv-02169-RDP).

Excellus’s corporate representative confirmed that it receives information about the 

geographic location of a group’s employees during the application process through a census. 

(Doc. # 218, Ex. 8 at 103, Case No. 2:12-cv-02169-RDP). The representative did not know how 

 18 Subscriber and Provider Plaintiffs have calculated the amount of premiums obtained by Excellus from 

Northern District subscribers, and Excellus has not disputed their calculations. (See Doc. # 222 at 4, Case No. 2:12-

cv-02169-RDP).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 16 of 63
17

Excellus stored residential information about its subscribers. (See id.). The representative also 

was unaware of how many Excellus subscribers lived in Alabama or the Northern District. (Id.

at 104).

I. Blue Cross Blue Shield of Wyoming (“BCBS-WY”)

BCBS-WY is a Wyoming company whose principal place of business is in Wyoming. 

(Doc. # 211, Ex. 3 at 1, Case No. 2:12-cv-02169-RDP). BCBS-WY has filed tax returns in 

Alabama for income that it derived from a partnership. (Id. at 2). Its affiant did not state how 

much income BCBS-WY derived from that partnership, but he noted that the income from this 

partnership constituted less than 0.01 percent of BCBS-WY’s total income per year. (Id.).

BCBS-WY has contracted with one laboratory located in the Northern District. (Id.). But its 

affiant does not state how much business BCBS-WY conducted with that laboratory. (See id.). 

According to a corporate representative, the laboratory, LabCorp, is headquartered in Alabama 

but has laboratories throughout the nation, including laboratories in Wyoming. (Doc. # 218, Ex. 

9 at 54-55, Case No. 2:12-cv-02169-RDP).

From 2013 to 2016, an average of 12 BCBS-WY members resided in Alabama each year, 

and approximately 4 of those members resided in the Northern District. (Id. at 3). From 2012 to 

2015, BCBS-WY collected an average of $40,936 per year in premiums from its members in 

Alabama. (Doc. # 220, Ex. 3 at 2, Case No. 2:12-cv-02169-RDP). And it collected an average 

of $12,508 per year in premiums from its members in the Northern District. (Id.). 

From 2012 to 2015, an average of 386 BCBS-WY members received health care services 

in Alabama through the BlueCard Program each year; of those members, an average of 343 

received heath care services each year in the Northern District. (Id. at 3). On average, BCBSCase 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 17 of 63
18

WY paid $94,411 per year to settle claims from providers in Alabama through the BlueCard 

Program, and it paid $86,708 per year to settle claims from providers in this district. (Id.).

BCBS-WY’s corporate representative asserted that it is not a control plan for a national 

account. (Doc. # 218, Ex. 9 at 65, Case No. 2:12-cv-02169-RDP). In most circumstances, 

BCBS-WY requires that a majority of a group plan’s employees must live in Wyoming in order 

for it to issue health insurance to that group. (See id. at 26-27).

J. Triple-S Salud (“Triple-S”)

According to an associate general counsel for Triple-S Management, Triple-S is licensed 

to conduct business in Puerto Rico and the U.S. Virgin Islands. (Doc. # 210, Ex. 1 at 1, Case No. 

2:12-cv-02169-RDP). For the years 2008 to 2015, Triple-S had a maximum of 4 members reside 

in Alabama and a maximum of 3 members that resided in the Northern District. (Id.). As of 

March 31, 2016, two Triple-S members reside in Alabama. (Id.). Fifteen (15) Triple-S members 

received healthcare services in Alabama from January 2015 to March 2016 through the BlueCard 

Program. (Id. at 2). In 2012, Triple-S received 781 claims from Alabama providers through the 

BlueCard Program.19 (Doc. # 369 at 9 & n. 25, Case No. 2:12-cv-02532-RDP). From 2011 to 

2015, Triple-S obtained approximately $42,360 in premiums from ten different Alabama 

subscribers. (Doc. # 218, Ex. 28, Case No. 2:12-cv-02169-RDP).

From 2008 to 2010, Triple-S paid approximately $735,000 to ActekSoft, a Birminghambased firm that produces software for the insurance and health care payer markets.

20 (Doc. # 

 19 Triple-S has not disputed this factual assertion by Provider Plaintiffs. (See Doc. # 382 at 4, Case No. 

2:12-cv-02532-RDP).

20 Triple-S has produced a spreadsheet outlining payments that it made to a single vendor. (Doc. # 218, 

Ex. 27 at 4, Case No. 2:12-cv-02169-RDP). The spreadsheet notes that three of the payments were made to 

“Actek.” However, neither the spreadsheet nor the cover letter sent by Triple-S’s counsel identified the vendor who 

received the rest of these payments. At oral argument, Triple-S’s counsel confirmed that all of the payments were 

made to ActekSoft, not just the payments identified by check marks placed on the document. (Doc. # 905 at 162, 

Case No. 2:13-cv-20000-RDP). Because the spreadsheet does not indicate that Triple-S received any discounts from 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 18 of 63
19

218, Ex. 27 at 4, Case No. 2:12-cv-02169-RDP). See also Lauren B. Cooper, California Firm 

Buys Birmingham’s ActekSoft, Birmingham Business Journal (Feb. 10, 2010, 12:17 PM), 

http://www.bizjournals.com/birmingham/stories/2010/02/08/daily16.html. Triple-S regularly 

paid ActekSoft several times each year. (See Doc. # 218, Ex. 27 at 4, Case No. 2:12-cv-02169-

RDP). Also, Triple-S paid BECPR, Inc. $5,000 in September 2010 and $10,000 in January 2011 

for professional consulting services. (Id. at 5-6).

According to Triple-S’s corporate representative, it does not know how many members 

live in Alabama because it relies on members to self-report their residences. (Doc. # 371, Ex. 7 

at 40-41, Case No. 2:12-cv-02532-RDP). But the representative provided inconsistent answers 

when asked whether Triple-S receives information about the geographic location of out-ofterritory subscribers before it issues health insurance to an employer headquartered in Puerto 

Rico. On the one hand, when asked whether Triple-S obtains documents from an employer 

showing the geographic location of its employees “as part of the due diligence for Triple-S 

providing coverage,” the representative responded that Triple-S receives such documents. (Id. at 

127). In addition, the representative testified that employers seeking group health coverage

inform Triple-S during negotiations whether they want Triple-S to provide health insurance to 

employees living outside of Puerto Rico. (Id. at 128). The representative also confirmed that 

Triple-S could sometimes learn of the geographic location of employees who would be covered 

by a proposed insurance group through a census of an employer. (Id. at 130). On the other hand, 

the representative testified that Triple-S clearly informs employers seeking health insurance “that 

the service area is Puerto Rico.” (Id. at 129-30). And she denied that Triple-S receives written

 

ActekSoft, the court infers that Triple-S paid ActekSoft the amount requested in its invoices, as reflected by the 

spreadsheet.

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 19 of 63
20

information concerning where potential subscribers reside when it decides whether to issue an 

insurance contract. (Id. at 131). 

K. BlueCard Program

The BlueCard Program allows a member of a Blue Plan to obtain health care services 

“while traveling or living in another [Blue Plan’s] Service Area” (Doc. # 369, Ex. 36 at 3, Case 

No. 2:12-cv-02532-RDP). The Program allows a member to receive the benefits provided by 

their Home Plan while accessing the “provider networks and savings” from the Host Plan. (Id.). 

When a member of an out-of-area Blue Plan receives medical services from a health care 

provider, the provider submits a claim to the local Host Plan, not the member’s Home Plan. (Id.

at 5). The Host Plan “validates the provider information and applies its pricing . . . using a set of 

standard pricing methods and rules.” (Id.). The Host Plan must inform the out-of-area Home

Plan about the discounts and differentials that it receives from the health care provider. (Id. at 5-

6). When a Home Plan receives a BlueCard submission from a Host Plan, the Home Plan

reviews the member’s coverage and determines whether the member was eligible to receive the 

medical services rendered by the provider. (Id. at 6). The Home Plan approves or denies the 

claim and sends its adjudication to its member. (Id.). Also, it sends a disposition of the claim to 

the Host Plan, which includes an authorization to pay the provider, standard administrative 

expense allowances, and any applicable “network access fee.” (Id.). The Host Plan may charge

a network access fee for “delivering the benefits of its provider contracts or networks” to an outof-area Blue Plan. (Id.). According to the Internal Revenue Service, “Access Fees are usually 

computed as a percentage of the savings between a provider’s standard rate and [the Host Plan’s] 

contracted rates.” (Id.).

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IV. Standard of Review

A Rule 12(b)(2) motion tests the court’s exercise of personal jurisdiction over a 

defendant. See Fed. R. Civ. P. 12(b)(2). “A plaintiff seeking the exercise of personal 

jurisdiction over a nonresident defendant bears the initial burden of alleging in the complaint 

sufficient facts to make out a prima facie case of jurisdiction.” United Techs. Corp. v. Mazer, 

556 F.3d 1260, 1274 (11th Cir. 2009); see also Posner v. Essex Ins. Co., 178 F.3d 1209, 1214 

(11th Cir. 1999) (“A plaintiff seeking to obtain jurisdiction over a nonresident defendant initially 

need only allege sufficient facts to make out a prima facie case of jurisdiction.”). If a plaintiff 

satisfies his initial burden and a defendant then challenges personal jurisdiction by submitting 

affidavit evidence in objection to personal jurisdiction, the burden traditionally shifts back to the 

plaintiff to produce evidence supporting jurisdiction. See Meier ex rel. Meier v. Sun 

International Hotels, Ltd., 288 F.3d 1264, 1269 (11th Cir. 2002); see also Posner, 178 F.3d at 

1214 (“The plaintiff bears the burden of proving ‘by affidavit the basis upon which jurisdiction 

may be obtained’ only if the defendant challenging jurisdiction files ‘affidavits in support of his 

position.’” (citation omitted)). When the issue of personal jurisdiction is decided on the 

evidence, but without a discretionary hearing, a plaintiff demonstrates a “prima facie case of 

personal jurisdiction” by submitting evidence sufficient to defeat a motion made pursuant to 

Rule 50(a) of the Federal Rules of Civil Procedure. See Snow v. DirecTV, Inc., 450 F.3d 1314, 

1317 (11th Cir. 2006). At this evidentiary juncture, the court construes the complaints’

allegations as true if they are uncontroverted by affidavits or deposition testimony, id., and where 

there are conflicts, the court “construe[s] all reasonable inferences in favor of the plaintiff[s].” 

Whitney Info. Network, Inc. v. Xcentric Ventures, LLC, 199 F. Appx. 738, 741 (11th Cir. 2006)

(unpublished) (quoting Meier, 288 F.3d at 1269).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 21 of 63
22

A Rule 12(b)(3) motion tests whether venue is proper in the court selected by a plaintiff. 

See Fed. R. Civ. P. 12(b)(3). “When venue is challenged by a Rule 12(b)(3) motion, [a] plaintiff 

has the burden of showing that venue in the forum is proper.” Pritchett v. Paschall Truck Lines, 

Inc., 714 F. Supp. 2d 1171, 1172 (M.D. Ala. 2010). The court must accept the complaint’s 

allegations as true, unless those allegations are contradicted by a defendant’s affidavit testimony. 

Id. If an allegation in the complaint is challenged, “the court may examine facts outside of the 

complaint to determine whether venue is proper” and “may make factual findings necessary to 

resolve motions to dismiss for improper venue.” Id. (quoting Bryant v. Rich, 530 F.3d 1368, 

1376 (11th Cir. 2008)).

V. Analysis

Provider Plaintiffs and Subscriber Plaintiffs have provided four possible grounds to 

justify the court’s exercise of personal jurisdiction over Moving Defendants. First, according to 

Plaintiffs, Section 12 of the Clayton Act grants the court personal jurisdiction over Moving 

Defendants because all Moving Defendants transact business in Alabama and the court’s 

exercise of personal jurisdiction comports with the Fifth Amendment’s Due Process Clause. 

Second, all Moving Defendants are subject to personal jurisdiction under Alabama’s long-arm 

statute because they are parties to a conspiracy and at least one of their co-conspirators has taken 

overt acts in furtherance of the conspiracy in Alabama. Third, Alabama’s long-arm statute 

authorizes personal jurisdiction over Moving Defendants because they have established 

minimum contacts with the state of Alabama, and the court’s exercise of personal jurisdiction 

comports with the Fourteenth Amendment’s Due Process Clause. Finally, Plaintiffs claim that

personal jurisdiction is appropriate under Alabama’s long-arm statute because Moving 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 22 of 63
23

Defendants have committed an intentional tort and the effects of that tort were aimed towards 

Alabama.

Additionally, Provider Plaintiffs and Subscriber Plaintiffs argue that venue is proper in 

this court for two reasons. First, Section 12 of the Clayton Act, in addition to establishing 

personal jurisdiction in this court, establishes venue in this district because all Moving 

Defendants transact business within this district. Second, venue is proper in this district under 28 

U.S.C. § 1391(b)(2) because a substantial part of the actions giving rise to Defendants’ market 

allocation conspiracy occurred in this district. 

The court first will address whether Section 12 of the Clayton Act establishes personal 

jurisdiction and venue in this district under the integrated approach. Then, the court will 

examine whether it may exercise personal jurisdiction over Moving Defendants under the 

conspiracy theory of personal jurisdiction. Next, the court will address whether Moving 

Defendants have established minimum contacts in Alabama by purposefully availing themselves 

of the privilege of conducting business in this state.21 Finally, the court will discuss whether 

venue is proper in this court under 28 U.S.C. § 1391, the general venue statute.

 21 After careful review and lengthy deliberation, the court concludes that it need not determine whether 

Moving Defendants are subject to the court’s personal jurisdiction under the effects test applied in Calder v. Jones, 

465 U.S. 783 (1984). Most of the cases applying the Calder effects test to antitrust actions use the test to 

demonstrate that a foreign defendant has expressly aimed its conduct towards the United States as a whole, rather 

than towards a particular state. See, e.g., In re Magnetic Audiotape Antitrust Litigation, 334 F.3d 204, 207-08 (2d 

Cir. 2003). And, although the Ninth Circuit has applied the Calder effects test to establish personal jurisdiction over 

domestic defendants, the defendants in that case had made “wash sales” and had conducted other acts to manipulate 

the natural gas market in a particular state, Wisconsin. See In re Western States Wholesale Natural Gas Antitrust 

Litigation, 715 F.3d 716, 742-45 (9th Cir. 2013), aff’d sub nom., Oneok, Inc. v. Learjet, Inc., 135 S. Ct. 1591 (2015). 

Here, in contrast, Moving Defendants have a stronger argument that their market allocation scheme was not directed 

at a particular state. Rather, to the extent any scheme existed, it was conducted nationwide and was, by all accounts, 

intended to have nationwide effect. Because the court finds that Moving Defendants are subject to the court’s 

personal jurisdiction on three alternative grounds, it declines to rule upon whether they are subject to personal 

jurisdiction in Alabama under the Calder effects test.

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 23 of 63
24

A. The Court May Exercise Personal Jurisdiction Over Moving Defendants 

Under Section 12 of the Clayton Act Because Venue is Proper in This District 

Against All Moving Defendants Under Section 12

Provider and Subscriber Plaintiffs both assert that Moving Defendants are subject to the 

court’s personal jurisdiction because the actions currently at issue are brought under the antitrust 

laws and Moving Defendants conduct substantial business within the Northern District of 

Alabama. (See Doc. # 218 at 8-19, Case No. 2:12-cv-02169-RDP; Doc. # 369 at 3-14, Case No. 

2:12-cv-02532-RDP). In challenging this basis for personal jurisdiction and venue, Moving 

Defendants first argue that they do not conduct substantial business within the Northern District 

because (1) they do not meet the factors for conducting substantial business in this district, and 

(2) only a small percentage of their members have resided in this district or received health care 

services from providers in this district.22 Second, Moving Defendants assert that the court’s 

exercise of personal jurisdiction under Section 12 does not comport with their due process rights 

because it would impose an unreasonable burden on them, the federal interests present in these 

actions do not outweigh that burden, and they only have limited and incidental contacts with 

Alabama.23 

For the reasons explained below, the court concludes that venue is proper in the Northern 

District for the claims against all Moving Defendants under Section 12 of the Clayton Act 

because all Moving Defendants have conducted substantial business in this district. 

Accordingly, for the following reasons, the court finds that venue is proper in this court under 

Section 12 of the Clayton Act, for that reason it may exercise personal jurisdiction over 

 22 (See Docs. # 209 at 4-8; 210 at 18 ; 211, Memorandum of Certain Defendants in Support of Motion to 

Dismiss for Lack of Personal Jurisdiction and Improper Venue, at 9-10; 212 at 4; 213 at 6, Case No. 2:12-cv-02169-

RDP).

23 (See Docs. # 209 at 8; 210 at 19-23; 211, Memorandum of Certain Defendants in Support of Motion to 

Dismiss for Lack of Personal Jurisdiction and Improper Venue, at 10-13; 213 at 6-7, Case No. 2:12-cv-02169-RDP).

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 24 of 63
25

Defendants under Section 12, and that this exercise of personal jurisdiction does not offend the 

Due Process Clause of the Fifth Amendment. 

i) The Relevant Legal Standards

Under Section 12 of the Clayton Act:

Any suit, action, or proceeding under the antitrust laws against a corporation may 

be brought not only in the judicial district whereof it is an inhabitant, but also in 

any district wherein it may be found or transacts business; and all process in such 

cases may be served in the district of which it is an inhabitant, or wherever it may 

be found.

15 U.S.C. § 22. Section 12 contains both a personal jurisdiction provision and a venue provision 

for corporate defendants sued under the antitrust laws. KM Enters., Inc. v. Global Traffic Techs., 

Inc., 725 F.3d 718, 724 (7th Cir. 2013). Venue is appropriate in any district where the 

corporation (1) is an inhabitant, (2) is found, or (3) transacts business.24 Id. Section 12’s 

personal jurisdiction clause “provides for nationwide (indeed, worldwide) service of process and 

therefore nationwide personal jurisdiction.” Id.

Section 12 of the Clayton Act enlarged the specific antitrust venue provision contained in 

Section 7 of the Sherman Act, which had permitted plaintiffs to bring an antitrust suit in any 

district where a corporate defendant could be found or resided. United States v. Scophony Corp. 

of America, 333 U.S. 795, 804-05 (1948). Congress enacted Section 12 to “relieve[ ] persons 

injured through corporate violations of the antitrust laws from the often insuperable obstacle of

resorting to distant forums for redress of wrongs done in the places of their business or 

residence.” Id. at 808 (internal quotation marks omitted). Thus, “Section 12 venue is broader 

than venue under either the Sherman Act or the general venue statute as it existed in 1914.” KM 

Enters., 725 F.3d at 730. Nevertheless, although Congress intended for the Clayton Act to 

 24 Neither group of Plaintiffs has argued that any of the Moving Defendants are an inhabitant of the 

Northern District or that they can be found in the Northern District. Thus, the court’s discussion is limited to the 

transacts-business prong for establishing venue under Section 12.

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 25 of 63
26

provide broader procedural remedies for plaintiffs who had suffered antitrust injuries, “it was . . . 

quite careful in expanding venue, rejecting several broader proposals than the one finally enacted 

in Section 12.” Daniel v. Am. Bd. of Emergency Medicine, 428 F.3d 408, 425 (2d Cir. 2005) 

(quoting United States v. National City Lines, 334 U.S. 573, 588 (1948)). Instead, “it created 

specific limits on venue—limits that for many corporations would result in a set of permissible 

districts much smaller than the entire United States.” KM Enters., 725 F.3d at 730. 

In an earlier opinion, the court addressed the ongoing circuit split on the issue of whether 

the personal jurisdiction and venue clauses of Section 12 must be applied in conjunction or 

whether a plaintiff can mix and match these clauses with other statutory provisions. In re Blue 

Cross Blue Shield Antitrust Litigation, 26 F. Supp. 3d 1172, 1194-96 (N.D. Ala. 2014). In that 

opinion, the court noted that the Eleventh Circuit had not addressed (as of the time of the 

opinion) the circuit split. Id. at 1195. To the court’s knowledge, the Eleventh Circuit still has 

not addressed this circuit split. In the absence of binding authority, the court adopted the 

majority “integrated” approach, as best articulated by the Seventh Circuit in its KM Enterprises

opinion. Id. at 1196. Thus, “[t]o avail oneself of the privilege of nationwide service of process, 

a plaintiff must satisfy the venue provisions of Section 12’s first clause. If she wishes to 

establish venue exclusively through Section 1391, she must establish personal jurisdiction some 

other way.” KM Enters., 725 F.3d at 730.

Under Section 12, venue is appropriate for an antitrust suit against a corporate defendant 

in any district where the defendant engages in “any substantial business operations.” Scophony 

Corp., 333 U.S. at 807. A court must judge whether a defendant transacts substantial business in 

a district “from the point of view of the average businessman and not in proportion to the sales or 

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27

revenues of the defendant.” Black v. Acme Markets, Inc., 564 F.2d 681, 687 (5th Cir. 1977).25 

Both purchases by a defendant in a district and sales by a defendant in a district are considered 

transactions of business for purposes of Section 12. Id. And the purchases and sales considered 

by a court to determine whether a defendant has conducted substantial business in a district need 

not be connected to the subject matter of the antitrust suit. Id. A corporation can transact 

business within a district even if all of the relevant transactions are interstate in character. King 

v. Johnson Wax Assocs., Inc., 565 F. Supp. 711, 716 (D. Md. 1983). 

According to the King opinion, “courts generally are in agreement that a corporation’s 

contacts with a district must be somewhat regular and continuous; meager, sporadic dealings 

within the district are not sufficient.” Id. Although there is no “singular definitive test for 

transacting business,” the most important factor to consider is “the dollar amount of business 

transacted in the district.” In re Chicken Antitrust Litigation, 407 F. Supp. 1285, 1291 (N.D. Ga. 

1975). 

At oral argument and in their briefs, the Moving Defendants have pointed the court to 

certain authority in support of their arguments that the court should consider the percentage of 

their total business conducted within this district as a factor weighing against the propriety of 

Section 12 venue in this district. (See, e.g., Doc. # 209 at 5-6, Case No. 2:12-cv-02169-RDP 

(citing KM Enterprises, Jung v. Association of American Medical Colleges, 300 F. Supp. 2d 119

(D.D.C. 2004), Sanderson v. Spectrum Labs, Inc., 227 F. Supp. 2d 1001 (N.D. Ind.), aff’d, 248 

F.3d 1159 (7th Cir. 2000) (unpublished), and Buckeye Associates, Ltd. v. Fila Sports, Inc., 616 F. 

 25 In Bonner v. City of Prichard, Ala., 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc), the Eleventh Circuit 

adopted as binding precedent all Fifth Circuit decisions handed down prior to the close of business on September 30, 

1981. The court has not discovered any Eleventh Circuit opinion discussing in any detail the test for “transacting 

business” under Section 12. Cf. DeLong Equip. Co. v. Washington Mills Abrasive Co., 840 F.2d 843, 855 n. 16 

(11th Cir. 1988) (declining to address whether venue was proper in a district court under Section 12 of the Clayton 

Act because it was proper under 28 U.S.C. § 1391). 

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28

Supp. 1484 (D. Mass. 1985), in support of BCBS-MS’s Section 12 venue argument; (see also

Doc. # 211, Memorandum of Certain Defendants in Support of Motion to Dismiss for Lack of 

Personal Jurisdiction and Improper Venue, at 9-10, Case No. 2:12-cv-02169-RDP (citing KM 

Enterprises, Daniel, Sanderson, and Austad v. United States Steel Corp., 141 F. Supp. 437 (N.D. 

Cal. 1956), in support of five Moving Defendants’ Section 12 venue argument)). The problem 

for them in making this argument is that the authority they rely upon is non-binding and wholly 

inconsistent with binding precedent in the former Fifth Circuit which addresses Section 12’s 

application in determining when a corporation has transacted substantial business in a particular 

district. Over sixty years ago, in Green v. United States Chewing Gum Manufacturing Co., the 

former Fifth Circuit reviewed whether a chewing gum manufacturer had transacted substantial 

business in a district where it had shipped gum to customers who had ordered it by mail but had

not solicited business from those customers within the district. 224 F.2d 369, 369-70 (5th Cir. 

1955). Like the Moving Defendants in these cases, the gum manufacturer in Green challenged 

the propriety of venue under Section 12 by averring that the business it obtained from the 

Northern District of Texas was “a very small part of [its] total business.” Id. at 370-71. It had

only two regular customers in the district, sold 6,000 pounds of chewing gum per month to 

customers in the district, and had approximately $25,000 per year in sales within the district. Id. 

The Fifth Circuit held that the manufacturer’s deliveries to the district constituted substantial 

business within the meaning of the Act. Id. In so holding, the former Fifth Circuit rejected the 

defendant’s argument that Section 12 venue was inapplicable because the defendant had

conducted only a small percentage of its total business in the district. Id. at 371-72. “[F]or if 

that were the rule, we would have different tests of substantiality applying to different 

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29

corporations according to their size; a large corporation could, with impunity, engage in the same 

acts which would subject a smaller corporation to jurisdiction and venue.”26 Id. at 372.

This binding precedent continued in Black. There, the former Fifth Circuit held that 

venue was proper in the district where the suit had been filed because the defendant had

purchased nearly $1.5 million in products from the district in one year. 564 F.2d at 687-88. It 

noted that the defendant had purchased approximately $375,000 in aluminum foil directly from a 

manufacturer in the district and further stated (in a footnote) that this purchase alone was 

sufficiently significant to support venue under Section 12. Id. at 687 & n. 10. The court 

concluded that venue could also be supported by the defendant’s purchases from a corporation 

headquartered in the district, which totaled more than $1 million, even though an unspecified 

portion of those purchases were made through a broker in another district. Id. at 687 n. 10. 

Similarly, the former Fifth Circuit held in another case that a single sale within a district was 

sufficient to establish venue under Section 12 where the defendant personally solicited the 

plaintiff’s business in Alabama, made an offer to the plaintiff, and agreed to license films to the 

plaintiff for $32,000, payable over 35 months. Pape Television Co. v. Associated Artists Prod. 

Corp., 277 F.2d 750, 751-52 (5th Cir. 1960).

 26 During oral argument, counsel for BCBS-MS insisted that the former Fifth Circuit looked to the nature 

of a defendant’s industry in order to determine whether it had conducted substantial business in a district, referring 

to Datamedia Computer Service, Inc. v. AVM Corp., 441 F.2d 604 (5th Cir. 1971). (Doc. # 905 at 146, Case No. 

2:13-cv-20000-RDP). But the Datamedia Computer opinion provides no help to Moving Defendants on this issue

for two reasons. First, the Datamedia Computer court relied on Green’s holding that the court must look to the 

average businessperson’s point of view, not the percentage of business that the defendant transacted within the 

district, to determine whether that defendant conducted substantial business in a district. See Datamedia Computer, 

441 F.2d at 606, 608. Second, the Datamedia Computer court considered the nature of a defendant’s industry to 

explain why that defendant had conducted substantial business even though it had made only periodic sales in the 

district. Id. at 608 (“We are here dealing with an industry which, by its very nature, makes sales, and can expect to 

make sales, only at intervals, governed largely by the periodical nature of the electoral process.”). Moreover, as

discussed more fully below, the Datamedia Computer panel simply was not authorized to depart from Green’s rule 

that a small percentage of business in a district does not allow an antitrust defendant to escape the drop of Section 

12’s net.

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30

As an initial matter, the court concludes that the Moving Defendants’ “percentage of 

revenue” approach to the substantial business test heads in the wrong direction. Although they

cite several opinions (most of which arise from the Seventh Circuit or district courts within that

circuit) that have considered the percentage of a defendant’s sales in a particular district as a 

factor relevant to whether a defendant had conducted substantial business within a district, the 

court finds this approach is off the mark.

27 Some courts, particularly those in the Seventh 

Circuit, consider the percentage of sales within a district as a factor when determining whether a 

corporation has conducted substantial business within that district. See KM Enters., 725 F.3d at 

731-32 (noting that a defendant’s “negligible sales” constituted “the weakest support for venue” 

where its $2,327 of direct sales in a district constituted 0.002 percent of its total sales during a 

four year period). But the binding precedent in our circuit expressly prohibits this court from 

considering the percentage of a defendant’s purchases or sales within the Northern District when 

reviewing whether a defendant has conducted substantial business within this district. Black, 

564 F.2d at 687; Green, 224 F.2d at 371-72.

Furthermore, even if binding precedent did not foreclose this court from applying the 

percentage of revenue approach advocated here (and, to be clear, it does), such an approach does 

not comport with the basic principles behind Section 12’s transacts-business test.28 First, the 

Supreme Court recognized in Scophony Corporation that the transacts-business prong of Section 

12 “sloughed off the highly technical distinctions . . . glossed upon” the Sherman Act’s venue 

provision in favor of a “practical and broader business conception of engaging in any substantial 

 27 (E.g., Doc. # 209 at 5-6, Case No. 2:12-cv-02169-RDP (citing KM Enterprises, Sanderson, Jung, and 

Buckeye Associates); Doc. # 211, Memorandum of Certain Defendants in Support of Motion to Dismiss for Lack of 

Personal Jurisdiction and Improper Venue, at 9, Case No. 2:12-cv-02169-RDP (citing KM Enterprises, Sanderson,

and Industrial Models, Inc. v. SNF, Inc., 2015 WL 2399089, at *2 (N.D. Ill. May 18, 2015) (unpublished))).

28 On this issue, the court disagrees with the Seventh Circuit’s well-reasoned KM Enterprises opinion. 

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31

business operations.” Scophony Corp., 333 U.S. at 807. The percentage of revenue approach 

adds a technical factor that an antitrust plaintiff would be required to consider in determining 

whether a particular district is an appropriate venue under Section 12. That is, not only would a 

plaintiff be called upon to determine whether a defendant makes substantial sales or purchases in 

a district, it would also have to discern the percentage of a defendant’s total revenue that it 

obtained from sales in the district. The Green court emphatically rejected that application of 

Section 12 for this reason: such an approach favors large corporations over small corporations 

because, in marginal cases, a large corporation could make an identical amount of sales as a 

small business in a particular district but avoid jurisdiction under Section 12 based on its larger 

pool of total sales. Green, 224 F.2d at 371-72. Finally, as the Scophony Corporation Court 

observed, the transacts-business prong of Section 12 relieves antitrust plaintiffs of the burden of 

filing antitrust suits in far-flung districts. 333 U.S. at 808. Under the percentage of revenue 

approach, a large corporation can (consciously or otherwise) place the burden on a plaintiff to 

file suit in distant districts (or, in the instance of a conspiracy case, be forced to split its claims up 

among a number of districts), even where that corporation makes tens (or hundreds) of thousands 

of dollars in sales in a particular district at issue. For these reasons, the court declines to apply 

the percentage of revenue approach preferred by Moving Defendants.

ii) All Moving Defendants Have Conducted Substantial Business in the 

Northern District

The Moving Defendants have consistently argued that they are regional entities who each 

issue insurance contracts in a particular geographic service area and solicit business from that 

particular geographic area. But the affidavits submitted by Moving Defendants, along with the 

voluminous record produced by Provider and Subscriber Plaintiffs, paint a different portrait of 

the Moving Defendants. To be sure, each of the Moving Defendants only issues insurance 

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32

contracts within a specific geographic service area. But they all have subscribers throughout the 

United States (including some within in the Northern District), they all have entered into the 

BlueCard Program in order to access a nationwide provider network, and they all settle (and have 

settled) claims made by providers in the Northern District through the BlueCard Program. Thus, 

after careful review of the submitted evidence, the court finds that all of the Moving Defendants 

have engaged in substantial business activities within the Northern District. 

First, BCBS-MS clearly has transacted substantial business within the Northern District, 

as (1) it has received an average of $189,286.80 per year in premiums from subscribers in the 

Northern District from 2008 to 2013, and (2) its provider network has included nine physicians 

who reside in the Northern District. (Doc. # 218, Ex. 26, Case No. 2:12-cv-02169-RDP; Doc. # 

256, Ex. 1 at 1-2, Case No. 2:13-cv-20000-RDP). Frankly, it is incredible for BCBS-MS to 

assert that its collection of approximately $190,000 in premiums per year from approximately 

1,900 subscribers in this district constitutes de minimis business. That in itself would be enough 

for the court to conclude that BCBS-MS engages in substantial business in this district. But 

there is more. The court also notes the millions of dollars in payments that BCBS-MS has made 

to providers in the Northern District for treatment received by its members. (See Doc. # 218, Ex. 

26, Case No. 2:12-cv-02169-RDP). While BCBS-MS argues that its subscribers and network 

providers unilaterally located themselves in the Northern District, BCBS-MS accepted the indistrict providers into its network with knowledge that they resided in the Northern District. 

(Doc. # 256, Ex. 1 at 1-2, Case No. 2:13-cv-20000-RDP). Because of BCBS-MS’s substantial 

revenues from premiums paid by subscribers in the Northern District, and its inclusion of nine 

in-district providers within its provider network, the court finds that BCBS-MS conducts 

substantial business within the Northern District, notwithstanding the specific facts that BCBSCase 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 32 of 63
33

MS has introduced to show its lack of presence in the Northern District. Cf. King, 565 F. Supp. 

at 716 (confirming that a corporation can conduct substantial business in a district solely through 

interstate transactions).

Second, the court finds that HealthNow, Capital, BCBS-AZ, BCBS-ND, and Excellus

each conduct substantial business within the district, based on the amount of premiums and 

administrative fees that these companies have received from subscribers within the Northern 

District. According to their own affidavits, HealthNow collected approximately $900,000 per 

year in premiums from subscribers in the Northern District, BCBS-ND collected approximately 

$600,000 per year, and BCBS-AZ collected approximately $235,000 per year. (Doc. # 220, Exs. 

1 at 2, 3 at 2, 5 at 2, Case No. 2:12-cv-02169-RDP). And the submitted affidavits demonstrate 

that HealthNow, BCBS-AZ, and BCBS-ND consistently conduct substantial business with 

subscribers in the Northern District, even though those subscribers mainly enter the Blue Plans’ 

insurance networks through group insurance plans issued in the Blue Plans’ respective 

geographic service areas. (See id.). Likewise, Capital’s submitted affidavit demonstrates that it 

has conducted a large amount of business in the Northern District, as it received approximately 

$870,000 in premiums and administrative fees during an eight-month period in 2013. (See Doc. 

# 218, Ex. 24 at 2, Case No. 2:12-cv-02169-RDP). Capital has not indicated that its number of 

subscribers in this district has substantially decreased, nor has it provided more recent 

information about the amount of premiums and fees it has collected from Northern District 

subscribers. Finally, Excellus has admitted that it obtained $109,000 in premiums from

subscribers in the Northern District. (See Doc. # 222 at 4, Case No. 2:12-cv-02169-RDP). 

Thus, even though HealthNow, Capital, BCBS-AZ, BCBS-ND, and Excellus do not have offices 

or employees in the Northern District and do not issue insurance contracts in the Northern 

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34

District, they all have conducted substantial business here because they have received over 

$100,000 per year in premiums from this district. Cf. Green, 224 F.2d at 371, 374 (concluding 

that a corporation conducted substantial business in a district when it sold $25,000 of products in 

the district per year).

Third, the court finds with little difficulty that BCBS-KS has conducted substantial 

business within this district based on the number of subscribers and members BCBS-KS has

within the district and the considerable sum of money it pays to health care providers in this 

district for services received by its members. BCBS-KS has not provided the court with 

evidence regarding the amount of premiums it has received from subscribers in the Northern 

District. Since the court lacks easily reviewable evidence concerning the amount of premiums 

received by BCBS-KS, it has reviewed other factors to determine whether this Blue Plan has

conducted substantial business within the district. BCBS-KS has had well over 100 subscribers 

within the Northern District per year and has made over $500,000 in payments to health care 

providers within the district. Cf. Green, 224 F.2d at 371, 374 (affirming the propriety of venue 

under Section 12 where a defendant had two regular customers in a district). Moreover, BCBSKS has entered into the BlueCard Program in order to obtain discounts for health care services 

from an in-state corporation (BCBS-AL). BCBS-KS and the other Moving Defendants do not 

enter the BlueCard Program merely to obtain access to emergency or urgent medical care for 

traveling members. Rather, Moving Defendants know (or reasonably should know) that some of 

their members reside in Alabama, due to the hundreds or thousands of BlueCard claims each 

Moving Defendant receives from BCBS-AL, and they use the BlueCard Program to access 

discounted services from providers in this district. Plainly, these factors weigh heavily in favor 

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35

of finding that BCBS-KS has conducted substantial business within this district, notwithstanding 

its lack of offices and employees here.

BCBS-KS, along with other Moving Defendants, has argued that the presence of some of 

its members within this district does not establish that it transacts business here and has cited 

Golf City, Inc. v. Wilson Sporting Goods Co., 555 F.2d 426 (5th Cir. 1977), in support of this 

argument. The court is not convinced that the cases before it are analogous to Golf City. In Golf 

City, the Fifth Circuit held that the Professional Golf Association (PGA) did not transact 

substantial business within a district where (1) members of the PGA resided, (2) the PGA 

received free advertising through a golf magazine distributed in the district, (3) PGA 

membership applications were made available, and (4) the PGA granted memberships to a selfcreated club. 555 F.2d at 437-38. Here, unlike the PGA in the Golf City action, all of the 

Moving Defendants, including BCBS-KS and Excellus, have paying customers within this 

district and provide a service to those customers that requires them to pay third parties in this 

district for services rendered. Thus, the members of the Moving Defendants’ insurance groups 

are quite distinct from the members of a professional organization. In addition, Moving 

Defendants have transacted business in this district by entering into an agreement with another 

insurance company who maintains a provider network within this district (BCBS-AL) to provide 

access to medical services for insured parties. Thus, the court finds it appropriate here to 

consider the number of subscribers and members (or, in simpler language, customers) a Moving 

Defendant has within this district to determine whether it has conducted substantial business in 

this district.

Finally, the court considers whether BCBS-WY and Triple-S have conducted substantial 

business within the Northern District. These Defendants’ motions have presented a closer 

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36

question as they have historically maintained less than ten subscribers in this district. However, 

for the reasons discussed below, the court finds that both have conducted substantial business 

here, and venue is appropriate for the antitrust claims against them under Section 12 of the 

Clayton Act.

With regard to BCBS-WY, several facts demonstrate that it has conducted substantial 

business in this district. First, over a four year period, BCBS-WY has allowed approximately 

four members from the Northern District to remain in its insurance network. (Doc. # 211, Ex. 3 

at 3, Case No. 2:12-cv-02169-RDP). Cf. Green, 224 F.2d at 371, 374 (affirming the propriety of 

venue under Section 12 where a defendant had two regular customers in a district). Second, it 

has collected approximately $12,508 per year in premiums from its members in the Northern 

District. (Doc. # 220, Ex. 3 at 2, Case No. 2:12-cv-02169-RDP). Cf. Green, 224 F.2d at 371, 

374 (affirming the propriety of venue under Section 12 where a defendant made $25,000 

annually in sales in that district). Third, BCBS-WY has paid an average of approximately 

$86,700 per year through the BlueCard Program to settle claims from providers in this district. 

(Doc. # 220, Ex. 3 at 2, Case No. 2:12-cv-02169-RDP). Fourth, it has entered into the BlueCard 

Program and settled claims from Northern District providers through the BlueCard Program in 

order to provide its customers in the Northern District access to a provider network and to obtain 

discounts from those providers. Even upon consideration of the facts presented in BCBS-WY’s 

affidavits regarding its lack of traditional business activities in the state, the court concludes that 

BCBS-WY’s interstate transactions involving this district constitute substantial business under 

Section 12 of the Clayton Act. Therefore, BCBS-WY is subject to personal jurisdiction in this 

district.

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37

Likewise, Triple-S has conducted substantial business operations in the Northern District. 

Triple-S appears to have maintained two to three members in the Northern District during the 

period between 2008 and 2015. (Doc. # 210, Ex. 1 at 1, Case No. 2:12-cv-02169-RDP). Cf. 

Green, 224 F.3d at 371, 374 (holding that a manufacturer conducted substantial business in a 

district where it had two regular customers). And, even more significantly, from 2008 to 2011, 

Triple-S made over $750,000 in purchases from companies in this district. (Doc. # 218, Ex. 27, 

Case No. 2:12-cv-02169-RDP). Cf. Black, 564 F.2d at 687 & n. 10 (indicating that a single 

purchase of approximately $375,000 would qualify as substantial business operations in a 

district). In addition, Triple-S received over 700 claims for payment from Alabama providers in 

2012 through the BlueCard Program. (Doc. # 369 at 9 & n. 25, Case No. 2: 12-cv-02532-RDP). 

And, Triple-S entered into the BlueCard Program in order to receive discounted rates from health 

care providers throughout the United States, including those in the Northern District. Through 

the BlueCard Program, Triple-S received claims processing services from BCBS-AL, which is 

headquartered in the Northern District. Based on Triple-S’s large purchases in this district, the 

presence of some Triple-S members in this district, the significant number of BlueCard claims 

Triple-S received from subscribers in Alabama, and Triple-S’s receipt of discounted rates from 

health care providers through its participation in the BlueCard Program, the court concludes that 

Triple-S has conducted substantial business operations in this forum and is thus subject to 

personal jurisdiction in this district under Section 12.

iii. The Court’s Exercise of Personal Jurisdiction Under Section 12 of the 

Clayton Act Comports with the Fifth Amendment’s Due Process 

Clause

Moving Defendants argue that the court’s exercise of personal jurisdiction over them 

under Section 12 of the Clayton Act does not comport with due process. First, Moving 

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38

Defendants contend that litigating in this district imposes an unreasonable burden on them. (See,

e.g., Doc. # 211, Memorandum of Certain Defendants in Support of Motion to Dismiss for Lack 

of Personal Jurisdiction and Improper Venue, at 11-12, Case No. 2:12-cv-02169-RDP). 

Second, Moving Defendants claim that the federal interests in litigating these actions in this 

district do not outweigh the burdens imposed upon them because “there is no clear congressional 

intent for all alleged antitrust co-conspirators to be tried in the same court,” Section 12 does not 

establish nationwide venue or nationwide personal jurisdiction, and Plaintiffs’ federal rights can 

be vindicated in other forums. (See, e.g., id. at 12-13). The court disagrees with these

arguments.

Like the Fourteenth Amendment’s personal jurisdiction test, the Fifth Amendment’s Due 

Process Clause requires a defendant to have fair notice that its activities may subject it to a suit in 

a particular forum. Republic of Panama v. BCCI Holdings (Luxembourg) S.A., 119 F.3d 935, 

944-45 (11th Cir. 1997). A defendant may have fair warning if it has purposefully directed 

activities at residents of the forum. Id. at 945. When a court determines the constitutionality of 

exercising personal jurisdiction under the Fifth Amendment, though, the court must consider the 

United States as the relevant forum, not an individual state. Id. at 945 n. 16. Thus, where a 

defendant is a domestic corporation, that defendant has purposefully directed its activities 

towards the United States by incorporating in one of the states. Id. As all of the Moving 

Defendants are incorporated in the United States and issue insurance contracts within the United 

States, all of them have purposefully directed activity towards the United States.

The Fifth Amendment, like the Fourteenth Amendment, protects litigants from facing 

“the burdens of litigation in an unduly inconvenient forum.” Id. at 945. When evaluating 

whether jurisdiction is fair and reasonable under the Fifth Amendment, “courts should balance 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 38 of 63
39

the burdens imposed on the individual defendant against the federal interest involved in the 

litigation.” Id. at 946. But, before the court weighs the federal interests in maintaining the suit 

against those personal burdens, the defendant must present a “compelling case” that jurisdiction 

is unreasonable. Id. (quoting Burger King Corp. v. Rudzewicz, 471 U.S. 462, 477 (1985)).

When examining the burden on a defendant, a court must evaluate a defendant’s 

aggregate contacts with the nation as a whole. Id. at 946-47. In BCCI Holdings, the Eleventh 

Circuit held that the defendants had failed to present “any constitutionally significant 

inconvenience” and relied on three factors to support that holding. Id. at 948. First, the 

defendants were large corporations that provided services in metropolitan areas “along the 

eastern seaboard.” Id. Second, the BCCI Holdings action required worldwide discovery, 

indicating that Florida was not significantly more inconvenient to the defendants than other 

forums. Id. Finally, the defendants presented no evidence that the Florida forum would 

significantly compromise their ability to litigate the case. Id.

Here, as in BCCI Holdings, Moving Defendants have failed to demonstrate that the 

court’s exercise of personal jurisdiction under Section 12 would cause them to suffer 

constitutionally significant inconvenience. First, all of the Moving Defendants are relatively 

large corporations who conduct significant amounts of business within the United States. Cf. 

BCCI Holdings, 119 F.3d at 948. All of the Moving Defendants unquestionably have minimum 

contacts with the United States. Although each Moving Defendant primarily conducts business 

in a single geographic service area, the Eleventh Circuit considered the defendants’ lack of 

significant contacts with a particular state in the BCCI Holdings case and found that factor 

insufficient to override other factors favoring jurisdiction. See id. Second, this case has involved 

(and will continue to involve) nationwide discovery, so this forum is not significantly more 

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inconvenient to Moving Defendants than other possible forums in the United States. See id. 

Finally, as discussed in detail below, Moving Defendants have not demonstrated how the 

continued litigation of these antitrust claims in this district impairs their ability to defend 

themselves from the claims.29 Id. For these reasons, the court concludes that Moving 

Defendants have not demonstrated that they face “constitutionally significant inconvenience” 

from participating in these actions, and the court’s exercise of personal jurisdiction pursuant to 

Section 12 of the Clayton Act accordingly comports with the Fifth Amendment’s Due Process 

Clause. See id. Nevertheless, in the interest of completeness, the court will discuss the federal 

interests at stake in this case.

The federal interests presented by this case outweigh any burdens presented by Moving 

Defendants. The Supreme Court has described the federal interest in enforcing antitrust laws as 

“both familiar and substantial,” as the antitrust laws preserve “economic freedom and our freeenterprise system.” Cal. Retail Liquor Dealers Association v. Midcal Aluminum, Inc., 445 U.S. 

97, 110-11 (1980) (discussing the federal interest in antitrust enforcement as compared to the 

states’ interest in regulating liquor) (citing United States v. Topco Assocs., Inc., 405 U.S. 596, 

610 (1972)). Indeed, Congress exercised its full authority under the Commerce Clause in Article 

I of the Constitution when it enacted the Sherman Act. Id. at 111. This federal antitrust 

enforcement interest is particularly well-served by maintaining these antitrust actions in Alabama 

because Alabama is a market in which a Blue Plan (here BCBS-AL) has a particularly high share

of the health insurance market. (See, e.g., Doc. # 244 at ¶ 415, Case No. 2:13-cv-20000-RDP). 

The strong federal interest in antitrust enforcement clearly outweighs the Moving Defendants’ 

 29 The court observes that if BCBS-AL is found to have agreed to a nationwide antitrust conspiracy with 

other Blue Plans through the Association, all Moving Defendants would necessarily be confronted with any 

appropriate injunctive relief that Provider Plaintiffs and Subscriber Plaintiffs might have available to them in 

addressing that conspiracy.

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generalized assertions regarding burdens they will face by defending themselves in this forum. 

Moreover, as the Eleventh Circuit has recognized, a “strong federal interest” to have complex 

lawsuits conducted efficiently exists, and the procedure proposed by Moving Defendants would 

be inefficient because it would require Plaintiffs to file and litigate an antitrust suit in each forum 

where a Blue Plan operates. Delong Equip. Co. v. Washington Mills Abrasive Co., 840 F.2d 843, 

850-51 (11th Cir. 1988). As Provider and Subscriber Plaintiffs each allege one overarching 

antitrust conspiracy between the Blue Plans through the Association, from which other antitrust 

violations flow, it makes sense to litigate the antitrust claims in one court, rather than in several 

courts.

In conclusion, venue is proper in this district for these actions under Section 12 of the 

Clayton Act because all Moving Defendants have transacted substantial business within the 

Northern District. The court may exercise personal jurisdiction over all Moving Defendants 

under Section 12, and the court’s exercise of personal jurisdiction comports with the Fifth 

Amendment’s Due Process Clause. Accordingly, Moving Defendants’ motions to dismiss are 

due to be denied because personal jurisdiction and venue are appropriate under Section 12 of the 

Clayton Act.

B. Alternatively, Moving Defendants are Subject to this Court’s Personal 

Jurisdiction Because Plaintiffs Have Sufficiently Alleged a Conspiracy to 

Which All Moving Defendants are Parties

Both Provider and Subscriber Plaintiffs argue that Moving Defendants are subject to 

personal jurisdiction in Alabama because (1) Moving Defendants are parties to a conspiracy, (2) 

BCBS-AL has undertaken overt acts in furtherance of the conspiracy within Alabama, and (3) 

Moving Defendants were aware that the effects of the conspiracy would be felt in Alabama. 

(See, e.g., Doc. # 371 at 14-19, Case No. 2:12-cv-02532-RDP; Doc. # 218 at 24-29, Case No. 

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42

2:12-cv-02169-RDP). Moving Defendants contest this basis for personal jurisdiction on four

grounds. First, Moving Defendants assert that Provider and Subscriber Plaintiffs have made 

“vague and conclusory allegations of a conspiracy” that are insufficient, as a matter of law, to 

establish personal jurisdiction over nonresident parties to the alleged conspiracy. (See, e.g., Doc. 

# 211, Memorandum of Certain Defendants in Support of Motion to Dismiss for Lack of 

Personal Jurisdiction and Improper Venue, at 21, Case No. 2:12-cv-02169-RDP). Second, they 

argue that both Provider and Subscriber Plaintiffs have failed to allege that each Moving 

Defendant purposefully availed itself of the privilege of conducting business in Alabama. (See, 

e.g., id. at 22). Third, they contend that both Provider and Subscriber Plaintiffs have failed to 

allege a conspiracy that has a substantial connection to Alabama. (See, e.g., Doc. # 210 at 23-24, 

Case No. 2:12-cv-02169-RDP). Finally, they claim that the court’s exercise of personal 

jurisdiction pursuant to the Alabama long-arm statute would not comport with fair play and 

substantial justice. (See, e.g., Doc. # 211, Memorandum of Certain Defendants in Support of 

Motion to Dismiss for Lack of Personal Jurisdiction and Improper Venue, at 10-13, 22, Case No. 

2:12-cv-02169-RDP). The court disagrees with each of these contentions.

i) The Relevant Legal Standards

The determination of whether the exercise of personal jurisdiction over a nonresident 

defendant is appropriate involves a two-part analysis. See Cable/Home Communication Corp. v. 

Network Productions, Inc., 902 F.2d 829, 855 (11th Cir. 1990); see also Alexander Proudfoot 

Co. World Headquarters L.P. v. Thayer, 877 F.2d 912, 919 (11th Cir. 1989). First, the 

jurisdictional question under the state long-arm statute is considered. See Cable/Home 

Communication Corp., 902 F.2d at 855; see also Alexander Proudfoot Co., 877 F.2d at 919. 

Second, if there is a basis for the assertion of personal jurisdiction under the state statute (that is, 

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43

if there are minimum contacts with the forum), the next determination to be made is whether 

sufficient minimum contacts exist to satisfy the Due Process Clause of the Fourteenth 

Amendment so that “maintenance of the suit does not offend ‘traditional notions of fair play and 

substantial justice.’” International Shoe Co. v. Washington, 326 U.S. 310, 316 (1945) (quoting 

Milliken v. Meyer, 311 U.S. 457, 463 (1940)); see also Cable/Home Communication Corp., 902 

F.2d at 855; Alexander Proudfoot Co., 877 F.2d at 919. The nature and quality of the contacts 

may vary depending on whether the type of jurisdiction being asserted is specific or general. See 

Consolidated Dev. Corp. v. Sherritt, Inc., 216 F.3d 1286, 1291 (11th Cir. 2000). Only if both 

prongs of the analysis are satisfied may a federal or state court exercise personal jurisdiction over 

a nonresident defendant. 

The reach of the Alabama long-arm statute is a matter of Alabama law. Federal courts 

are required to construe the statute as would the Supreme Court of Alabama. See Oriental 

Imports & Exports, Inc. v. Maduro & Curiel’s Bank, N.V., 701 F.2d 889, 890-91 (11th Cir. 

1983). Alabama’s long-arm statute permits personal jurisdiction to the extent it “is not 

inconsistent with the constitution of this state or the Constitution of the United States.” Ala. R. 

Civ. P. 4.2(b). Thus, the real question here is whether assertion of personal jurisdiction over 

Moving Defendants comports with the Fourteenth Amendment’s Due Process Clause. See 

Olivier v. Merritt Dredging Co., 979 F.2d 827, 830 (11th Cir. 1992) (citing Alabama 

Waterproofing Co. v. Hanby, 431 So. 2d 141, 145 (Ala. 1983)). Compliance with the Fourteenth 

Amendment’s Due Process Clause exists where a defendant has minimum contacts with the 

forum state, and where the exercise of personal jurisdiction does not offend “traditional notions 

of fair play and substantial justice.” Olivier, 979 F.2d at 830-31 (quoting International Shoe, 

326 U.S. at 316); Madara v. Hall, 916 F.2d 1510, 1516 (11th Cir. 1990).

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The Alabama Supreme Court has recognized and adopted the conspiracy theory of 

personal jurisdiction. See Ex parte United Ins. Cos., 936 So. 2d 1049, 1055 (Ala. 2006); Ex 

parte McInnis, 820 So. 2d 795, 806-07 (Ala. 2001). Under a conspiracy theory, a defendant who 

otherwise may not be subject to personal jurisdiction might be hailed into court if the plaintiff 

“plead[s] with particularity the conspiracy as well at the overt acts within the forum taken in 

furtherance of the conspiracy.”30 McInnis, 820 So. 2d at 806-07 (internal quotation omitted)

(quoting Jungquist v. Sheikh Sultan Bin Khalifa Al Nahyan, 115 F.3d 1020, 1031 (D.C. Cir. 

1997)). The Alabama Supreme Court has stated, though, that this is not a heavy pleading 

burden. Ex parte Reindel, 963 So. 2d 614, 623 (Ala. 2007). In Reindel, that court held that a 

plaintiff had sufficiently pled a prima facie case of personal jurisdiction based on the conspiracy 

theory where the plaintiff alleged that the defendants had conspired to conceal the financial 

condition of a company through fraudulent financial reports and to commit investment fraud, 

which involved negotiations with the plaintiff in Alabama. Id. at 624. In another case, the 

Eleventh Circuit in an unpublished opinion held that a plaintiff had pled an overt act in 

furtherance of an investment fraud conspiracy in Alabama where it had alleged that a defendant 

made a presentation in Alabama to the plaintiff about enrolling in a plan. J&M Assocs., Inc. v. 

Romero, 488 F. Appx. 373, 376 (11th Cir. 2012).

In Ex parte Barton, the Alabama Supreme Court considered whether a defendant had 

sufficient contacts with the state of Alabama in a case where the plaintiffs relied on the 

conspiracy theory to support personal jurisdiction. 976 So. 2d 438, 443-47 (Ala. 2007). The 

Barton court stated that “[a]llegations of fraud or a civil conspiracy, in certain circumstances, 

have been held to be sufficient to establish personal jurisdiction over an alleged out-of-state 

 30 “The elements of civil conspiracy in Alabama are: (1) concerted action by two or more persons to (2) 

achieve an unlawful purpose or a lawful purpose by unlawful means.” J&M Assocs., Inc. v. Romero, 488 F. Appx 

373, 375 (11th Cir. 2012).

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conspirator.” Id. at 443. The Barton plaintiffs, who were residents of Alabama, alleged that the 

defendants had conspired to make misrepresentations to them so that the defendants would be 

included as partners in an entity that plaintiffs operated in Alabama. Id. at 445. The defendant 

who challenged the court’s personal jurisdiction presented general facts about his lack of 

contacts with Alabama, but did not contest the conspiracy allegations presented by the plaintiffs. 

See id. The Alabama Supreme Court held that the defendant had failed to establish a prima facie

lack of personal jurisdiction through his affidavit because (1) the affidavit did not challenge the 

conspiracy allegations in the complaint, which the court considered to be true, and (2) the 

conspiracy allegations demonstrated “contact through the conspiracy.” Id. at 446-47.

“Once it has been decided that a defendant purposefully established minimum contacts 

within the forum State, these contacts may be considered in light of other factors to determine 

whether the assertion of personal jurisdiction would comport with ‘fair play and substantial 

justice.’” Burger King, 471 U.S. at 476 (quoting International Shoe, 326 U.S. at 320). Such 

factors include “the burden on the defendant, the forum State’s interest in adjudicating the 

dispute, the plaintiff’s interest in obtaining convenient and effective relief, the interstate judicial 

system’s interest in obtaining the most efficient resolution of controversies, and the shared 

interest of the several States in furthering fundamental substantive social policies.” Id. at 477 

(quoting World-Wide Volkswagen Corp. v. Woodson, 444 U.S. 286, 292 (1980) (internal 

quotation marks omitted)). A court’s exercise of personal jurisdiction over a defendant does not 

violate due process when “these factors do not militate against otherwise permitted jurisdiction.” 

Licciardello v. Lovelady, 544 F.3d 1280, 1284 (11th Cir. 2008).

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ii) Provider and Subscriber Plaintiffs Have Adequately Pled that the 

Moving Defendants Entered Into the Conspiracies Alleged in This

Alabama Litigation

Moving Defendants contend that Plaintiffs have made only vague and conclusory 

allegations of an unlawful conspiracy, but that argument is amiss. Indeed, at a minimum, both 

Provider and Subscriber Plaintiffs have alleged that all Blue Plan Defendants, including Moving 

Defendants, agreed in 1987 to enter a Section 1 conspiracy to allocate geographic service areas 

by entering into License Agreements with the jointly-controlled BCBSA, through which they 

agreed (1) to only sell health insurance within a designated geographic service area under the 

Blue Cross and Blue Shield trademarks and (2) not to sell health insurance under the trademarks 

outside of their designated geographic service areas. (See, e.g., Docs. # 236 at ¶¶ 190, 192, 196; 

244 at ¶¶ 350-51, Case No. 2:13-cv-20000-RDP). These allegations present an adequately 

specific civil conspiracy by all Moving Defendants to violate Section 1 of the Sherman Act. See 

Aquatherm Indus., Inc. v. Fla. Power & Light Co., 145 F.3d 1258, 1262 (11th Cir. 1998) (“A § 1 

conspiracy to restrain trade . . . must allege 1) an agreement to enter a conspiracy, 2) designed to 

achieve an unlawful objective.”). In addition, Provider Plaintiffs have pled an adequately 

specific Section 1 conspiracy between the Blue Plans to fix prices for health care services by 

agreeing to not contract with health care providers outside of their designated geographic service 

areas and by agreeing to limit reimbursements paid by all Blue Plans to the rates negotiated by 

the Blue Plan within the provider’s geographic area. (See Doc. # 236 at ¶¶ 229-30). 

Accordingly, both Provider and Subscriber Plaintiffs have pled a conspiracy between Moving 

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Defendants and other Defendants with the particularity required under Alabama law to support 

personal jurisdiction over Moving Defendants.31 See McInnis, 820 So. 2d at 806-07.

iii) Provider Plaintiffs and Subscriber Plaintiffs Have Adequately Pled 

that BCBS-AL Took Actions in Furtherance of the Alleged 

Conspiracies in Alabama

After careful review of the complaints, the court concludes that both Provider and 

Subscriber Plaintiffs have adequately pled overt actions taken in Alabama in furtherance of the 

alleged conspiracies to which Moving Defendants allegedly agreed to join. 

Provider Plaintiffs have alleged that BCBS-AL enforced the price fixing conspiracy by 

reimbursing an Alabama hospital at a lower rate for in-network claims to account for a higher 

rate that the hospital had charged Blue Cross Blue Shield of Minnesota. (Doc. # 236 at ¶ 234, 

Case No. 2:13-cv-20000-RDP). Moreover, Provider Plaintiffs have asserted that BCBS-AL 

negotiated lower provider reimbursement rates with Alabama health care providers, prevented 

those providers from offering the same rates to other health insurance companies, and allowed 

other Blue Plans to access those supra-competitive rates obtained from providers through the 

BlueCard Program. (Id. at ¶¶ 326, 340). The court finds that all of these asserted actions would 

have furthered the market allocation conspiracy between the Blue Plans which Plaintiffs have 

alleged because they allowed other Blue Plans to offer a nationwide provider network while at 

the same time maintaining their geographic market allocations. Additionally, BCBS-AL has 

acted in Alabama to further the price fixing conspiracy by enforcing its terms against individual 

health care providers. Accordingly, Provider Plaintiffs have sufficiently alleged overt acts in 

Alabama by BCBS-AL that furthered the alleged antitrust conspiracies.

 31 The court is not suggesting that these are the only adequately-pled conspiracy claims in the operative 

Provider Plaintiff and Subscriber Plaintiff Complaints. In the interest of efficiency, the court refrains from 

reviewing the adequacy of every conspiracy claim in the operative complaints.

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Likewise, Subscriber Plaintiffs have adequately alleged that BCBS-AL has taken overt 

acts in furtherance of the nationwide conspiracies in the state of Alabama. First, they allege that 

BCBS-AL has agreed to only provide health insurance in Alabama under the Blue Cross and 

Blue Shield trademarks and has foregone opportunities to provide health insurance in other 

states. (Doc. # 244 at ¶ 351, Case No. 2:13-cv-20000-RDP). Second, they claim that all Blue 

Plans (including BCBS-AL) accept and process claims filed by health care providers in their 

designated geographic service areas through the BlueCard Program for out-of-state Blue Plans. 

(Id. at ¶ 236). Although the consolidated complaint does not specify that BCBS-AL acts as a 

Home Plan in the BlueCard Program, this fact has not been disputed. BCBS-AL acts in 

furtherance of the market allocation conspiracy by processing claims for other Blue Plans 

through the BlueCard Program because the BlueCard Program allows the Blue Plans to offer 

competitive health insurance services to national employers while maintaining their strict service 

area allocations. If BCBS-AL did not accept claims from in-state health care providers on behalf 

of other Blue Plans, the other Blue Plans would be compelled not to offer health insurance to 

individuals residing in Alabama or threaten the geographic service area allocation by contracting 

with providers in Alabama. Thus, BCBS-AL acts in furtherance of the alleged market allocation 

conspiracy by processing BlueCard claims on behalf of other Blue Plans, and its actions in 

furtherance of the alleged conspiracy support the court’s exercise of personal jurisdiction over 

Moving Defendants.

The Moving Defendants incorrectly argue that Plaintiffs must demonstrate that they 

purposefully directed activities towards Alabama in order to support personal jurisdiction 

through the conspiracy theory. Moving Defendants have cited this court’s opinion in Giraldo v. 

Drummond Co., 2012 WL 2358306 (N.D. Ala. June 20, 2012) (unpublished), aff’d sub. nom, 

Case 2:13-cv-20000-RDP Document 925 Filed 12/21/16 Page 48 of 63
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Doe v. Drummond Co., 782 F.3d 576 (11th Cir. 2015), cert. denied, 136 S. Ct. 1168 (2016), to 

support this argument. But the conspiracy allegations in the Giraldo litigation were far afield 

from those made by Plaintiffs in this case. In Giraldo, the plaintiffs alleged that certain 

defendants had formed a conspiracy in Colombia with a guerilla group to commit violations of 

the law of nations. See Giraldo, 2012 WL 2358306, at *1, 6. They also alleged that one 

defendant, James Adkins, had approved payments to the guerilla group in Alabama and had 

consented to strategic decisions while in Alabama, but did not allege that Adkins “had anything 

to do with war crimes and extrajudicial killings that occurred in Colombia.” Id. at *6. Thus, the 

court concluded that the plaintiffs in Giraldo had failed to plead a conspiracy connected to 

Alabama. See id. Here, in contrast, Provider and Subscriber Plaintiffs have pled that one 

conspirator, BCBS-AL, operates, sells insurance, and forms contracts with health care providers 

in Alabama. And, as explained more fully above, Plaintiffs have also pled that BCBS-AL acted

in Alabama to further the conspiracy on behalf of the other Blue Plans, including each of the

Moving Defendants. Thus, the court’s Giraldo opinion is inapposite to the facts presented here, 

as no conspirator in that case had committed actions in furtherance of the alleged conspiracy

while in Alabama. 

Likewise, Triple-S’s argument that the alleged conspiracies lack a substantial connection 

to Alabama is off the mark. (Doc. # 210 at 23-24, Case No. 2:12-cv-02169-RDP). As an initial 

matter, Triple-S relies on Matthews v. Brookstone Stores, Inc., 469 F. Supp. 2d 1056 (S.D. Ala. 

2007) for its proposed “substantial connection” standard, but Matthews does not cite any binding 

case law to support its observation that the conspiracy theory of personal jurisdiction generally 

requires a substantial connection between an alleged conspiracy and the forum state. See 

Matthews, 469 F. Supp. 2d at 1066 (citing Remmes v. International Flavors & Fragrances, Inc., 

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50

435 F. Supp. 2d 936, 941 (N.D. Iowa 2006)). And, perhaps even more importantly, this court 

has not discovered any Alabama Supreme Court opinion that requires a plaintiff to show a 

substantial connection between a conspiracy and the state of Alabama in order to rely upon the 

conspiracy theory to assert personal jurisdiction in Alabama. However, even assuming that the 

Matthews court correctly summarized the standard for pleading personal jurisdiction under the 

conspiracy theory, the court concludes that the overt acts committed by BCBS-AL in furtherance 

of the alleged conspiracies demonstrate a substantial connection between those conspiracies and 

Alabama.32

Accordingly, for these reasons, Provider and Subscriber Plaintiffs have sufficiently pled 

the requisite facts for the court to exercise personal jurisdiction over Moving Defendants under 

the conspiracy theory of personal jurisdiction. As none of the Moving Defendants have 

challenged the alleged conspiracies through affidavits or other evidence, the court accepts the 

Plaintiffs’ conspiracy allegations as true at this stage of the proceedings. See Barton, 976 So. 2d 

at 446-47 (denying a defendant’s request for mandamus relief on personal jurisdiction grounds 

where the court had to accept the plaintiff’s conspiracy allegations as true and the defendant had 

not contested those conspiracy allegations in his affidavit to the trial court).

iv) The Court’s Exercise of Personal Jurisdiction Over Moving 

Defendants Comports With Fair Play and Substantial Justice

Moving Defendants present several arguments as to why the court’s exercise of personal 

jurisdiction violates their due process rights under the Fourteenth Amendment. First, Moving 

 32 Provider and Subscriber Plaintiffs have pled other information from which a court may find a substantial 

connection between the alleged conspiracies and the state of Alabama. For example, Provider Plaintiffs have 

alleged that BCBS-AL controls 86 percent of the health care financing market in Alabama. (Doc. # 236 at ¶ 259, 

Case No. 2:13-cv-20000-RDP). They also have claimed that BCBS-AL has used its market power to include 

clauses in provider contracts that prohibit those providers from offering similar price discounts to other insurance 

companies. (Id. at ¶ 340). Similarly, Subscriber Plaintiffs have alleged that BCBS-AL uses its market power to 

obtain supra-competitive premiums from subscribers that rose at a higher annual rate than the national average. 

(Doc. # 244 at ¶¶ 418-19, Case No. 2:13-cv-20000-RDP).

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Defendants argue they would be unduly burdened by defending themselves in this forum because 

they do not solicit or conduct business in this forum and limit themselves to operating in certain 

geographic service areas. (See, e.g., Doc. # 211, Memorandum of Certain Defendants in Support 

of Motion to Dismiss for Lack of Personal Jurisdiction and Improper Venue, at 11, Case No. 

2:12-cv-02169-RDP). Second, they assert that Alabama does not have a significant interest in 

adjudicating this dispute because it has never issued a license to any Moving Defendant to sell 

insurance and Moving Defendants are not registered to do so in this state. (Id. at 11-12). Third, 

they contend that Plaintiffs can obtain relief for their claims in other forums because they have 

brought similar antitrust claims against Moving Defendants in the forums where each Moving 

Defendant operates. (Id. at 12; Doc. # 213 at 6, Case No. 2:12-cv-02169-RDP). Finally, one 

Moving Defendant claims that the court’s exercise of personal jurisdiction will not promote 

judicial efficiency because that type of efficiency is already being served by the multi-district 

nature of this litigation. (Doc. # 210 at 22, Case No. 2:12-cv-02169-RDP). After careful review, 

the court concludes that these arguments are unpersuasive. 

To start, Moving Defendants have not shown that they face “especially onerous” burdens 

from litigating in this forum or that the inconvenience of litigating in this forum rises to a 

“constitutional magnitude.” Diamond Crystal Brands, Inc. v. Food Movers International, Inc., 

593 F.3d 1249, 1274 (11th Cir. 2010). Indeed, Moving Defendants have provided little

indication to the court of what specific burdens they face from litigating in this forum, and 

generalized statements that litigation in a particular forum is burdensome are typically 

insufficient to show that the forum’s exercise of personal jurisdiction offends due process. See 

Grail Semiconductor, Inc. v. Stern, 2012 WL 5903817, at *5 (S.D. Fla. Nov. 26, 2012) 

(unpublished). For at least two decades, our court of appeals has recognized that “modern 

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methods of transportation and communication have significantly ameliorated” the burdens that 

corporations face when defending suits in states where they are not incorporated and do not have 

places of business. See Sculptchair, Inc. v. Century Arts, Ltd., 94 F.3d 623, 632 (11th Cir. 1996). 

The court certainly understands that such a burdensomeness argument by a foreign defendant 

would require close examination. Id. at 631. But here, all of the Moving Defendants are 

American corporations. Therefore, the court finds that Moving Defendants have failed to 

demonstrate that the court’s exercise of personal jurisdiction over them places a constitutionally 

significant burden upon them.

Additionally, the state of Alabama “has a very strong interest in affording its residents a 

forum to obtain relief from intentional misconduct of nonresidents causing injury in [Alabama].” 

Licciardello, 544 F.3d at 1288. Both Provider and Subscriber Plaintiffs have alleged that 

Moving Defendants intentionally entered into anticompetitive conspiracies that have caused 

significant harm to Alabama insurance purchasers and Alabama health care providers. With 

regard to Moving Defendants’ third argument, a plaintiff is not obligated to seek out a defendant 

in its home state in order to obtain redress from a defendant who through its conduct knowingly 

causes an injury in the plaintiff’s home state. Id. In this case, Provider and Subscriber Plaintiffs 

would face an especially burdensome task if they had to sue each Blue Plan in its home state for 

its participation in the alleged anticompetitive conspiracies because some thirty-nine (39)

currently operating Blue Plans and entities (including the Association) have been involved in the

alleged conspiracies.

Finally, the judicial interest in efficient resolution of this action is best served by the 

court’s exercise of personal jurisdiction over all Moving Defendants in the Alabama actions. 

Although the court currently is presiding over multi-district litigation involving the antitrust 

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claims against the Blue Plans and BCBSA, each case in the multi-district litigation is an 

individual action where defendants will be able to raise personal jurisdiction challenges (which 

have been expressly preserved with the blessing of this transferee court and all Plaintiffs) in the 

relevant transferor forum. And the Alabama residents in the putative Plaintiff classes, along with 

the judicial system, have an interest in “quick, convenient, and effective relief” that would be 

harmed by requiring Plaintiffs to file suit in each state for harms they suffered in Alabama from 

the alleged anticompetitive conspiracies. Olivier, 979 F.2d at 830, 834 (concluding that a

plaintiff should not have to file suit in two states against two insurance guaranty companies 

because multiple suits would waste judicial resources). 

In conclusion, as an alternative ground, the court finds that Moving Defendants are 

subject to personal jurisdiction under Alabama’s conspiracy doctrine of personal jurisdiction and 

that this exercise of personal jurisdiction comports with due process.

C. Alternatively, the Court May Exercise Specific Personal Jurisdiction Over 

Moving Defendants Because All Moving Defendants Have Sufficient 

Minimum Contacts with Alabama 

In their motions to dismiss, Moving Defendants provide several arguments as to why they 

lack minimum contacts with the state of Alabama. First, Moving Defendants contend that the 

presence of subscribers or in-network health care providers in this state does not demonstrate 

sufficient contacts with the state because these subscribers and providers have unilaterally 

located themselves in this forum. (Doc. # 209 at 9-10, Case No. 2:12-cv-02169-RDP). Second, 

they claim that they have not purposefully availed themselves in this forum by allowing their 

members to receive treatment through the BlueCard Program because “non-resident insurers’ 

membership in a national program that facilitates the provision of services to insureds . . . at 

discounted rates does not constitute purposeful availment.” (Doc. # 211, Memorandum of 

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Certain Defendants in Support of Motion to Dismiss for Lack of Personal Jurisdiction and 

Improper Venue, at 15-16, Case No. 2:12-cv-02169-RDP). Third, they claim that merely paying 

for services that health care providers in Alabama have rendered to subscribers does not establish 

personal jurisdiction. (Id. at 17). 

Provider Plaintiffs respond that Moving Defendants have established minimum contacts 

with Alabama because they “have availed themselves of the privilege of conducting business in 

Alabama through their participation in the BlueCard and National Accounts programs.” (Doc. # 

369 at 20, Case No. 2:12-cv-02532-RDP). They contend that Moving Defendants have invoked 

the protections of Alabama law because health care providers in Alabama have agreed to accept 

subscribers from out-of-state Blue Plans through the BlueCard Program, and those providers’ 

contracts with BCBS-AL are governed by Alabama law. (Id. at 22). Moreover, all of the 

Moving Defendants have subscribers who reside in Alabama, and the Northern District in 

particular, and those subscribers all rely on the BlueCard Program to receive health care services. 

(Id.). “All the moving Defendants knowingly cover Alabama residents, and all of them pay 

BlueCard claims submitted on behalf of Alabama residents.” (Id. at 23). Thus, for these reasons 

also, the court determines that (1) all Moving Defendants have sufficient minimum contacts with 

Alabama such that they were on notice that they may be hailed into its courts, and (2) Plaintiffs’ 

antitrust claims arise from Moving Defendants’ contacts with Alabama.

i. The Relevant Legal Standards

The exercise of specific jurisdiction is proper over a nonresident defendant when he “has 

‘purposefully directed’ his activities at residents of the forum, and the litigation results from 

alleged injuries that ‘arise out of or relate to’ those activities.” Burger King, 471 U.S. at 472-73, 

475 (internal citations omitted). The requirement that there be minimum contacts is grounded in 

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fairness. It assures that “the defendant’s conduct and connection with the forum State [is] such 

that he should reasonably anticipate being haled into court there.” World-Wide Volkswagen, 444 

U.S. at 297.

To show that litigation “arises out of” the activities in the forum state, the Eleventh 

Circuit does not use “mechanical or quantitative” tests. See Oldfield v. Pueblo De Bahia Lora, 

S.A., 558 F.3d 1210, 1222 (11th Cir. 2009). Nevertheless, it is “not enough that there [is] some 

similarity between the activities that connect the defendant to the forum and the plaintiff’s 

claim.” Licciardello, 544 F.3d at 1284 n. 3 (internal emphasis omitted). Rather, the defendant’s 

contacts with the forum must be related to the “operative facts of the controversy.” Id. (quoting 

CompuServe, Inc. v. Patterson, 89 F.3d 1257, 1267 (6th Cir. 1996)). Questions of specific 

jurisdiction are examined in the context of the particular claims asserted – here, those claims are 

grounded in intentional tort. To determine jurisdiction, “a court properly focuses on ‘the 

relationship among the defendant, the forum, and the litigation.’” Calder v. Jones, 465 U.S. 783, 

788 (1984) (quoting Shaffer v. Heitner, 433 U.S. 186, 204 (1977)).

Moving Defendants have pointed the court to a few opinions where courts have 

addressed whether a health insurer’s payment of claims from health care providers established 

minimum contacts within the provider’s forum of residence. For example, in Choice Healthcare, 

Inc. v. Kaiser Foundation Health Plan of Colorado, the Fifth Circuit considered whether Kaiser, 

a group of health maintenance organizations (“HMOs”), was subject to specific personal 

jurisdiction in Louisiana, a state where its insureds received treatment at a hospital. See

generally 615 F.3d 364 (5th Cir. 2010). The Kaiser entities did not enroll Louisiana residents 

into their insurance plans, but they had entered into a contract with a preferred provider network 

in order to receive discounted rates for health care services provided by certain entities in 

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Louisiana. Id. at 366-67. The plaintiffs, Louisiana health care providers, had rendered health 

care services to approximately fifty (50) individuals in Kaiser plans during a three-year period. 

Id. at 367. The Fifth Circuit held that Louisiana courts lacked specific personal jurisdiction for 

claims arising from the payments made to plaintiffs for medical services provided to Kaiser 

insured individuals. Id. at 369-72. According to the Fifth Circuit, Kaiser’s pre-treatment 

approval of medical care for its insureds and “payment of a limited number of claims for 

treatment” in Louisiana did not demonstrate that Kaiser purposefully directed commercial 

conduct towards Louisiana because (1) Kaiser directed individuals in the HMOs to obtain health 

care services within the area that the insureds lived and worked, (2) Kaiser only provided out-ofarea coverage for emergency care and urgent health needs, and (3) Kaiser insured individuals 

“fortuitously required such [emergency] treatment” in Louisiana. Id. at 369-70. The Fifth 

Circuit determined that “Kaiser [had] made the payments because its insureds independently and 

without encouragement from Kaiser presented to a Louisiana hospital for urgent care while 

visiting Louisiana.” Id. at 370.

Likewise, in a case involving an insurance coverage dispute, a district court held that 

Blue Cross Blue Shield of Louisiana’s participation in the BlueCard Program did not constitute 

purposeful availment in Texas on the basis that Blue Cross Blue Shield of Louisiana could 

reasonably foresee that its insureds would receive covered health care services in Texas. St. 

Luke’s Episcopal Hosp. v. La. Health Service & Indemnity Co., 2009 WL 47125, at *7-10 (S.D. 

Tex. Jan. 6, 2009) (unpublished) (favorably cited in Choice Healthcare, 615 F.3d at 371-72). 

First, the court determined that “merely providing out-of-state health coverage to insureds does 

not subject an insurer to personal jurisdiction in every foreign state in which an insured happens 

to obtain medical services.” Id. at *8. Second, the court considered whether entering into the 

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BlueCard Program constituted purposeful availment in a state where a Blue Plan received 

discounts for services by medical providers in that state.33 Ultimately, in St. Luke’s, the court

concluded that a Blue Plan’s entry into the BlueCard Program did not demonstrate that it had 

purposefully availed itself of the benefits and privileges of operating in Texas because the 

BlueCard Program did not involve a Texas contract, a contract between a Blue Plan and a Texas 

health care provider, or a substantial connection to Texas, since the BlueCard Program was 

operated by a national organization (BCBSA). See id. at *9.

ii. Analysis of Moving Defendants’ Minimum Contacts with Alabama

Here, in contrast to Choice Healthcare and St. Luke’s, the court finds that all Moving 

Defendants have sufficient minimum contacts with Alabama to demonstrate that they have 

purposefully availed themselves of the privilege of conducting business in this state. The court 

acknowledges St. Luke’s conclusion that a Blue Plan’s mere participation in the BlueCard 

Program is insufficient to demonstrate that a Blue Plan has purposefully directed commercial 

activities towards this state. But Plaintiffs in these cases have presented evidence showing more. 

That is, Plaintiffs have shown that Moving Defendants did more than pay claims from Alabama 

health care providers through the BlueCard system. Indeed, the record available to this court

reveals that the Moving Defendants have agreed to provide health insurance to group plans that 

include employees who reside in multiple states, including Alabama, and that they know the 

addresses of many applicants to their health plans before they agree to establish a group plan.

Representatives from four of the Moving Defendants testified in their depositions that 

those particular Moving Defendants receive the addresses of employees who are covered by 

 33 The court in St. Luke’s identified certain aspects of the BlueCard Program that could support the 

conclusion that a Blue Plan purposefully avails itself of the benefits of operating in a state by participating in the 

program. These factors include the ability to obtain discounted rates from health care providers in that state through 

contracts in that state between an in-state insurer and in-state providers and the processing of claims in the forum 

state by an in-state insurer pursuant to the BlueCard Program. St. Luke’s, 2009 WL 47125, at *8.

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certain group insurance plans before the Moving Defendants issue a group policy. (See, e.g., 

Doc. # 371, Ex. 37 at 50-51, Case No. 2:12-cv-02532-RDP; Doc. # 218, Exs. 4 at 39, 9 at 25, 15 

at 22, Case No. 2:12-cv-02169-RDP). Although the Moving Defendants issue their group 

insurance policies in states other than Alabama, Moving Defendants generally know that some of 

their subscribers are located outside of their respective geographic service areas when they issue 

group plans to employers with locations in multiple states, including Alabama. Moreover, they 

know (or reasonably should know) that their subscribers in Alabama will use covered health care 

services in Alabama that are paid for through the BlueCard Program. Thus, the evidence before 

this court demonstrates that Moving Defendants have purposefully availed themselves of the 

privileges of conducting business in Alabama by (1) entering into contracts to provide health 

insurance that include subscribers in Alabama, (2) collecting premiums from Alabama 

subscribers, and (3) entering into the BlueCard Program in order to access provider discounts 

negotiated by BCBS-AL. 

Unlike the Choice Healthcare and St. Luke’s cases, the antitrust claims in Plaintiffs’ 

complaints arise from both the Moving Defendants’ contracts to provide health insurance to 

groups that include Alabama subscribers and the BlueCard Program. This is so because 

Subscriber Plaintiffs have alleged that Moving Defendants, along with other Blue Plans, have 

charged supra-competitive premiums to subscribers by conspiring to limit their expansion so that 

each geographic service area only has one Blue Plan. Moreover, Provider Plaintiffs’ claims also 

arise from these geographic market allocations, which restrict the Blue Plans’ ability to contract 

with providers outside of a specific geographic service area. And the BlueCard Program furthers 

the goals of the market allocation conspiracy by allowing all Blue Plans to access provider 

discounts in other states without creating provider networks in other states that could threaten the 

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cohesion of the market allocations. In contrast, the Choice Healthcare and St. Luke’s cases 

involved coverage disputes arising from care provided to individuals who did not reside in the 

forum state and fortuitously needed care in the forum state. See Choice Healthcare, 615 F.3d at 

369-72; St. Luke’s, 2009 WL 47125, at *7-10. Such coverage claims are not connected to a 

health insurer’s contracts that cover subscribers in the forum state.

Accordingly, the court finds that Moving Defendants have availed themselves of the 

privileges of conducting business in Alabama, such that this court may exercise specific personal 

jurisdiction over them under Alabama’s long-arm statute. In addition, for the reasons explained 

above, the court’s exercise of personal jurisdiction over Moving Defendants does not violate 

their due process rights. For these reasons, the court finds, in the alternative, that Moving 

Defendants’ motions to dismiss are due to be denied because the court may exercise personal 

jurisdiction over them based on their minimum contacts with Alabama.

D. Venue is Appropriate in the Northern District Under 28 U.S.C. § 1391

In their motions to dismiss, Moving Defendants make three arguments with respect to 

venue. First, they assert that venue is not proper under Section 1391(b)(1) because the Moving 

Defendants, who are all corporations, are not subject to personal jurisdiction in Alabama. (See, 

e.g., Doc. # 211, Memorandum of Certain Defendants in Support of Motion to Dismiss for Lack 

of Personal Jurisdiction and Improper Venue, at 23-24, Case No. 2:12-cv-02169-RDP). Second, 

they contend that Provider and Subscriber Plaintiffs’ allegations fail to show that a substantial 

part of the acts giving rise to the claims occurred in this district. (See, e.g., id. at 24). Third, they 

argue that venue is not appropriate under Section 1391(b)(3) because Provider and Subscriber 

Plaintiffs have failed to prove that the action cannot be brought in another district where venue is 

appropriate for all defendants. (See, e.g., id.). In response to these contentions, Plaintiffs claim 

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that venue is proper in this district under Section 1391(b)(2) because a substantial part of the 

actions giving rise to this case occurred in the Northern District, where BCBS-AL is 

headquartered. (Doc. # 218 at 31-32, Case No. 2:12-cv-02169-RDP). Plaintiffs have the better 

of the arguments.

As the relevant statute makes plain, venue is appropriate in “a judicial district in which 

any defendant resides” or in “a judicial district in which a substantial part of the events or 

omissions giving rise to the claim occurred.” 28 U.S.C. § 1391(b)(1)-(2). In a state with more 

than one judicial district, a corporate defendant resides in any district in that state “within which 

its contacts would be sufficient to subject it to personal jurisdiction if that district were a separate 

state.” Id. § 1391(d). 

Here, as already discussed above, all Moving Defendants are corporate entities, and their 

contacts with this district are sufficient to subject them to personal jurisdiction under the 

conspiracy theory of personal jurisdiction. This is so because BCBS-AL, a co-conspirator, 

committed overt acts within this district in furtherance of the antitrust conspiracies alleged in the 

complaints. Significantly, BCBS-AL paid discounted rates to at least one health care provider in 

Alabama to account for higher payments that the provider had received from an out-of-state Blue 

Plan. (Doc. # 236 at ¶ 234, Case No. 2:13-cv-20000-RDP). Then, BCBS-AL shared the 

discount it received from the provider with the out-of-state Blue Plan, furthering the market 

allocation and group boycott conspiracies by encouraging other Blue Plans to not negotiate with 

providers in Alabama for lower rates. (See id.). And BCBS-AL accepted claims from Alabama 

health care providers through the BlueCard Program on behalf of other Blue Plans, sent the 

claims to the out-of-state Blue Plans for adjudication, and paid the in-state health care providers 

at its own negotiated rates to settle those claims. (See id. at ¶ 236) (describing how health care 

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providers obtain reimbursement for providing care to a person insured by an out-of-state Blue 

Plan). BCBS-AL’s processing of Blue Card claims sent by providers in this district furthered the 

alleged conspiracies by allowing out-of-state Blue Plans to access health care providers residing 

in the Northern District while complying with the market allocation conspiracy. Accordingly, 

because all Moving Defendants are corporate defendants who are subject to personal jurisdiction 

in this district under the conspiracy theory, venue is proper in this district under Section 

1391(b)(1).

The court notes that the vast majority of the defendants in these actions, including the 

Association, have not contested personal jurisdiction and venue.34 See Fed. R. Civ. P. 

12(h)(1)(B). To the extent that the court must have personal jurisdiction over all corporate 

defendants in order for venue to be proper in this court under Section 1391(b)(1), the court notes 

that Plaintiffs have alleged that all Blue Plan Defendants were parties to the conspiracies and that 

all Blue Plans entered into Licensing Agreements with the Association. Moreover, it finds that 

 34 The court is still unsure why some of the Blue Plan Defendants have argued against personal jurisdiction 

and the propriety of venue when a number of Blue Plans who are similarly situated did not file motions on these 

grounds. Even after the extensive briefing and submissions presented by Moving Defendants, the court remains

befuddled for the same reasons it discussed with the parties during the first round of discussions on these issues:

Mississippi claims that there’s no in personam jurisdiction over here, but Hawaii, California, 

Georgia, Florida, and Tennessee don’t claim that.

Pennsylvania says no jurisdiction here, but not Virginia, West Virginia, [and] North Carolina. In 

New York, several entities - - a couple entities in New York claim that, but not Rhode Island,

Connecticut, New Hampshire, Massachusetts, or Delaware.

Kansas claims it, but not Nebraska or Kansas City. North Dakota and Wyoming claim it, but not 

South Dakota, Montana, [or] Washington State. And Arizona claims it but not New Mexico or 

Nevada.

Now, maybe they all just have always had a lifelong dream of [litigating] in the Northern District 

of Alabama, or maybe they’ve heard I’m the most fun judge in the federal judiciary. I doubt those 

two things are true.

(Doc. # 347 at 17-18). And as the court asked during the first round of oral argument on the personal jurisdiction 

and venue motions: “If these are solid winning arguments, why am I not hearing them from other Blues who are 

perhaps even more attenuated than Capital with 386 subscribers here or Mississippi that camps on the border of the 

western edge of the state?” (Doc. # 371 at 26).

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the Association is a corporation which allegedly agreed to enter into the conspiracies, accepted 

control over the Blue Cross and Blue Shield trademarks, and subsequently entered into Licensing 

Agreements with the Blue Plans that contained geographic market limitations. Thus, all of the 

defendants in these actions are corporations who are subject to the court’s personal jurisdiction 

under the conspiracy doctrine, and venue is proper in this district under Section 1391(b)(1).

Alternatively, the court concludes that venue is appropriate in this district for the claims 

against BCBS-MS under Section 1391(b)(2). Admittedly, the record does not indicate where the 

Blue Plans negotiated or signed the Licensing Agreements with the Association. See Jenkins 

Brick Co. v. Bremer, 321 F.3d 1366, 1372 (11th Cir. 2003) (concluding that Georgia was the 

appropriate venue for claims arising from a violation of a non-compete clause where the contract 

at issue was presented to defendant in Georgia and signed in Georgia). Having said that, 

Plaintiffs’ antitrust claims did not arise solely from the execution of the Licensing Agreements 

(i.e., the written agreements that memorialized the allocation of geographic markets). Those 

claims also arose from the Blue Plans’ collective refusal to compete outside of their allocated 

geographic service areas and their creation of the BlueCard Program and National Accounts 

Program, which permitted the Blue Plans to provide health insurance services to employers with 

employees outside of discrete geographic service areas. In these Alabama cases, BCBS-AL’s 

actions in Alabama constitute a substantial part of the activities giving rise to the market 

allocation conspiracy between BCBS-AL and geographically contiguous Blue Plans. This is so 

because, at a minimum, BCBS-AL processes BlueCard claims in Alabama for Blue Plans in 

geographically contiguous service areas so that geographically contiguous Blue Plans can sell 

health insurance to group plans with employees in Alabama without creating a competing 

provider network in Alabama. If BCBS-AL did not participate in the BlueCard Program, there is 

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a substantial question as to whether BCBS-MS would create a competing provider network in 

portions of Alabama -- and portions of the Northern District -- in order to obtain discounts for 

covered services to its thousands of subscribers and members in Alabama and the Northern 

District. Indeed, BCBS-MS already contracts with nine providers who reside in the Northern 

District. (Doc. # 256, Ex. 1 at 1-2, Case No. 2:13-cv-20000-RDP). Accordingly, the court 

concludes that a significant part of the actions giving rise to the claims by Alabama plaintiffs 

against BCBS-MS have occurred in the Northern District.

VI. Conclusion

For the reasons explained above, the court concludes that Moving Defendants are subject 

to the court’s personal jurisdiction under Section 12 of the Clayton Act and Alabama’s long-arm 

statute. Moreover, the court’s exercise of personal jurisdiction through each of these avenues

comports with Moving Defendants’ due process rights. Finally, venue is proper in this district 

under Section 12 of the Clayton Act and under 28 U.S.C. § 1391. Therefore, Moving 

Defendants’ motions to dismiss are due to be denied. The court will enter separate orders on the 

master docket and in the four active Alabama cases in this multi-district litigation.

DONE and ORDERED this December 21, 2016.

_________________________________

R. DAVID PROCTOR

UNITED STATES DISTRICT JUDGE

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