How Blue Cross Blue Shield Settlement Payments Work and What to Expect
What the Blue Cross Blue Shield settlement means for you
Blue Cross Blue Shield companies agreed to pay out money to settle lawsuits over how they denied or delayed payment for emergency room visits and other urgent care. The settlement does not come automatically — you have to submit a claim form with proof that you received emergency care and were denied or delayed payment by Blue Cross Blue Shield between specific dates. The dates and dollar amounts vary depending on which Blue Cross Blue Shield plan you had and which state you lived in.
This is not a class action where everyone gets paid the same amount. Your payout depends on what you claim and what documentation you can provide. The settlement administrator — the company handling all the claims — reviews each submission and decides whether to approve it, reduce it, or deny it.
Key Takeaways
- You must file a claim with the settlement administrator using the official claim form; money is not sent automatically to anyone.
- You need proof of the emergency care you received and documentation showing Blue Cross Blue Shield denied or delayed payment for it.
- The claim deadline varies by settlement, but most have already passed; check the settlement website to confirm whether claims are still open.
- Approved claims are paid by check or direct deposit, usually within several weeks after approval.
- If your claim is denied, you can submit additional documentation or file an objection, but the process and timeline depend on which settlement you are part of.
Which Blue Cross Blue Shield settlement applies to you
Multiple Blue Cross Blue Shield entities have settled separate lawsuits, so the one you are part of depends on your state and which Blue Cross Blue Shield plan covered you. For example, settlements exist for Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Massachusetts, and others. Each settlement has its own claim deadline, its own settlement administrator, and its own rules about what counts as a valid claim.
The easiest way to find out which settlement you are part of is to search online for "Blue Cross Blue Shield settlement" plus your state name. The settlement website for your state will list the claim deadline, the types of claims accepted, and the contact information for the settlement administrator. If you cannot find it, call the customer service number on your old Blue Cross Blue Shield insurance card and ask which settlement you are covered under.
What documentation you need to file a claim
The settlement administrator will ask for proof of three things: that you received emergency care, that Blue Cross Blue Shield was your insurer at the time, and that the company denied or delayed payment for that care. Start by gathering your emergency room bill or urgent care bill from the date you received treatment. This bill should show the provider's name, the date of service, the services you received, and the amount charged.
Next, find documentation showing that Blue Cross Blue Shield denied the claim or took longer than the law allows to pay it. This could be a denial letter from the insurance company, an explanation of benefits (EOB) showing the claim was denied, or a letter from the provider saying Blue Cross Blue Shield had not paid by a certain date. If you do not have these documents, contact Blue Cross Blue Shield directly and ask them to send you copies of the claim history for that specific date of service. You can also contact the emergency room or urgent care provider and ask them to send you proof of what happened with the claim.
Finally, you will need proof that you were covered by Blue Cross Blue Shield on the date you received care. Your insurance card, a copy of your policy, or a letter from Blue Cross Blue Shield confirming your coverage dates all work for this.
How to submit your claim
Go to the settlement website for your state and download the official claim form. Do not use a form from any other website — the settlement administrator only accepts the official form. Fill out every section, including your name, address, phone number, the date you received emergency care, the name of the provider, and the amount you were charged.
Attach copies (not originals) of all your documentation to the form. Make a list of what you are sending so the settlement administrator knows what to expect. Mail everything to the address listed on the settlement website, or submit it online if the website offers that option. Keep a copy of everything you send for your own records.
The settlement administrator will send you a letter confirming that they received your claim. If they need more information, they will contact you by mail or phone. Do not assume your claim was received if you do not get a confirmation letter within two weeks of mailing it.
Timeline for claim review and payment
After the settlement administrator receives your claim, they typically take four to eight weeks to review it and make a decision. During this time, they are checking that your documentation matches what they have on file from Blue Cross Blue Shield and verifying that your claim fits the settlement rules. You will receive a letter in the mail telling you whether your claim was approved, denied, or approved for a reduced amount.
If your claim is approved, payment is usually sent within two to four weeks after the approval letter. You can choose to receive payment by check or direct deposit. If you choose direct deposit, provide your bank account number and routing number on the claim form or in a follow-up letter to the settlement administrator.
If your claim is denied or reduced, the denial letter will explain why. You will have a set amount of time (usually 30 to 60 days, depending on the settlement) to submit additional documentation or file an objection. The settlement website lists the exact deadline and the process for objecting.
What to do if your claim is denied
Read the denial letter carefully to understand the reason. Common reasons for denial include: the claim is outside the settlement date range, Blue Cross Blue Shield was not your insurer on that date, the care was not emergency care, or the documentation does not prove that Blue Cross Blue Shield denied or delayed payment.
If you believe the denial is wrong, gather any additional documentation that addresses the reason for denial. For example, if they said the care was not emergency care, get a letter from the provider explaining why it was an emergency. If they said Blue Cross Blue Shield was not your insurer, get a copy of your policy or a letter from Blue Cross Blue Shield confirming your coverage dates. Mail this additional documentation to the settlement administrator with a letter explaining why you think your claim should be approved.
If the settlement administrator denies your claim a second time, you may have the right to file a formal objection or appeal, depending on which settlement you are part of. The settlement website will explain whether this option is available and what the deadline is.
Common reasons claims are delayed or denied
The most common reason for delay is incomplete documentation. If your claim form is missing information or if your attached documents do not clearly show what happened with your claim, the settlement administrator will contact you to ask for more. Respond as quickly as you can — delays on your end add weeks to the process.
Claims are denied when the care falls outside the settlement date range, when Blue Cross Blue Shield was not your insurer at the time, or when the documentation does not prove that the company denied or delayed payment. Some settlements only cover emergency room visits, not urgent care or other types of care, so make sure you understand what your settlement covers before you file.
If Blue Cross Blue Shield paid the claim eventually, even if it was late, some settlements do not count that as a valid claim. Read the settlement rules on the website to see whether your situation qualifies.
Frequently Asked Questions
Can I file a claim if I already received a payment from Blue Cross Blue Shield?
It depends on the settlement. Some settlements only cover claims that were denied outright; others cover claims that were paid late. Check the settlement website for your state to see what types of claims are covered. If you are unsure, submit the claim anyway and let the settlement administrator decide — they will contact you if they need clarification.
What if I cannot find the original bill or denial letter?
Contact Blue Cross Blue Shield and ask them to send you a copy of the claim history for that date of service. Also contact the emergency room or urgent care provider and ask them to send you documentation of what happened with the claim. If neither organization has records, explain this in a letter to the settlement administrator and send whatever documentation you do have — they may still approve your claim.
How much money will I get if my claim is approved?
The amount varies based on what you claim and what the settlement rules allow. Some settlements pay a flat amount per claim; others pay based on the amount you were charged or the amount Blue Cross Blue Shield should have paid. The settlement website will explain how payments are calculated. Your payout could range from a few hundred dollars to several thousand dollars, depending on your specific claim.
What if I miss the claim deadline?
Most settlement deadlines have already passed. Check the settlement website for your state to see if claims are still open. If the deadline has passed, you generally cannot file a claim, though some settlements allow late claims if you can show you had a good reason for missing the deadline. Contact the settlement administrator to ask whether a late claim is possible.
Do I have to pay taxes on the settlement payment?
Settlement payments for denied or delayed medical claims are typically not taxable income, but tax rules can be complex. Keep your settlement approval letter and payment documentation in case you need them for tax purposes. If you are unsure, speak with a tax professional or contact the IRS.