The Court has preliminarily approved the certification of a class for settlement purposes. The Court decided that everyone who fits the following description is a member of the “Settlement Class”:

All Georgia residents who at any time were enrolled in a Pathway Plan effective during any period from January 1, 2016, to December 31, 2022. Excluded from the Settlement Class are (i) any judicial officer presiding over the Action and the members of his/her immediate family and judicial staff; (ii) BCBS-GA Counsel, their employees, and their immediate family, (iii) Class Counsel, their employees, and their immediate family, and (iv) any person who validly Opted Out of the Settlement Class.

BCBS-GA has agreed to create the $9.9 million Settlement Amount. If the Settlement receives final approval, the Settlement Amount will first be used to pay (1) Court-awarded attorneys’ fees, reimbursement of costs, and Service Awards; (2) Notice and Administration Expenses; (3) Taxes, if any; and (4) any other costs, fees, or expenses approved by the Court. The term “Notice and Administration Expenses” means all costs, fees, and expenses incurred in connection with providing Notice and distributing the Settlement proceeds to you. The money remaining after these fees and costs are deducted is the “Distributable Settlement Amount.” The Distributable Settlement Amount will be paid to the Settlement Class Members with Qualifying Billed Charges.

“Qualifying Billed Charge(s)” are:

For Settlement Class Members In Records: the 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 For Settlement Class Members in Records and Settlement Class Members Not In Records: a billed charge from a health care provider to the member which is not in BCBS-GA’s records but that the member attests they received because (1) the provider was out-of-network when BCBS-GA had represented that it was in-network in a provider directory or other communication on or before the date the member received the healthcare service; (2) BCBS-GA processed (or the member understood that BCBS-GA would have processed) the claim as out-of-network even though the provider was in-network on the date the healthcare service was received; (3) the specialist service was not covered for a claim denied because the member did not obtain a referral from their primary care physician (2019 plan year only); or (4) a primary care physician charged a fee to obtain a referral to a specialist (2019 plan year only). Except as to category (4), a Qualifying Billed Charge does not include copays or coinsurance amounts for in-network services.

Settlement Class Members In Records can look up the amount of Qualifying Billed Charges in BCBS-GA’s records that will be used for the pro rata calculation of their Settlement Payment. If you are a Settlement Class Member in Records and have any other billed charge from a health care provider that you believe qualifies as a Qualifying Billed Charge but is not reflected in BCBS-GA’s records, you had to submit a valid and timely Claim Form and required documentation in order for such additional claim(s) to be considered by the Settlement Administrator for financial payment under the Settlement.

Each Settlement Class Member In Records who did not Opt Out of the Settlement and any Settlement Class Member Not In Records who submitted a Claim Form with valid Qualifying Billed Charges, shall receive his or her pro rata share of the Settlement Amount. The Settlement Administrator shall determine the pro rata percentage that will be used to determine each Class Member’s Settlement Payment based on their total Qualifying Billed Charges.

The actual amount that each Settlement Class Member will receive will ultimately depend on a variety of factors, including the fees and expenses awarded by the Court and expended by the Settlement Administrator, the number of Settlement Class Members who chose to Opt Out of the Settlement, and the number of Settlement Class Members Not In Records who timely returned a valid Claim Form.

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