What is this Settlement about?
The lawsuit alleges that BCBS-GA (i) misrepresented the scope of its healthcare provider network to consumers who purchased an individual or family Pathway health insurance plan from BCBS-GA beginning in the November 2015 open enrollment period for the 2016 plan year; and (ii) improperly required Pathway members to obtain a referral from a primary care physician in order to see a specialist for the 2019 plan year. The Court has not decided whether Plaintiffs or Defendant would win this case. Instead, both sides agreed to the Settlement before any judgment was entered.
What does the Settlement provide?
BCBS-GA has agreed to create a $9.9 million settlement fund, which will be distributed to Settlement Class Members after first deducting any attorneys’ fees and costs, notice and administration expenses and service awards that the Court awards Plaintiffs and the attorneys representing the Class. The amount remaining in the Settlement Amount after deduction of fees, expenses and/or service awards shall be the “Distributable Settlement Amount”. In return, Settlement Class Members will be providing BCBS-GA with a release of claims.
Who is included?
The Court has preliminarily certified a Settlement Class consisting of non-excluded Georgia residents enrolled in a BCBS-GA Pathway Plan between January 1, 2016, and December 31, 2022. BCBS-GA will fund a $9.9 million Settlement Amount, which will first cover Court-approved fees, costs, any taxes, and administration expense. The remaining Distributable Settlement Amount will be paid to Settlement Class Members who have Qualifying Billed Charges.
A “Qualifying Billed Charge” is either a non-covered billed charge amount that appears in BCBS-GA’s records for any claim denied on the basis of the provider being out-of-network, or a billed amount a member attests they received due to an out-of-network issue—such as BCBS-GA listing a provider as in-network when they were not, processing a claim as out-of-network when the provider was actually in-network, or certain 2019 plan-year referral-related denials. A Qualifying Billed Charge does not include copays or coinsurance amounts for in-network services.
For more information about the Settlement Class, including details on who is excluded from the Class and what is considered a Qualifying Billed Charge, see FAQ 5.
Your Legal Rights and Options in this Settlement
These deadlines may be moved, canceled, or otherwise modified, so please check this site regularly for updates.
| Option & Due Date | Status | Event Description |
|---|---|---|
Submit a Claim Form February 26, 2026 | Status: Upcoming | Explanation: If you are a Settlement Class Member in Records and have any other billed charge that you believe qualifies as a Qualifying Billed Charge but is not reflected in BCBS-GA’s records, or if you are a Settlement Class Member Not In Records with valid Qualifying Billed Charges, you can submit a Claim Form for those charges. See FAQ 6 for more information. |
Exclude Yourself ("Opt Out") February 26, 2026 | Status: Upcoming | Explanation: If you don’t want to be part of the Settlement, or if you want to keep the right to sue or continue suing BCBS-GA on your own about the Released Claims, then you must exclude yourself ("Opt Out") from the Settlement Class. See FAQ 10 for more information. |
Object to the Settlement February 26, 2026 | Status: Upcoming | Explanation: If you do not exclude yourself from the Settlement Class, then you can object to the Settlement if you don’t agree with any part of it. You can provide reasons why you think the Court should deny approval of the Settlement by filing an objection. See FAQ 15 for more information. |
Do Nothing | Explanation: If you received notice by mail (or believe you meet the definition of the Settlement Class), and you do nothing and the Settlement reaches Final Approval, then you will be a Settlement Class Member. Even if you do not submit a Claim Form, you will be bound by the Settlement’s release and other terms. |
