Listen to this article A growing number of healthcare providers are opting out of class action settlements—and with good reason. In the landmark $2.8 billion Blue Cross Blue Shield (BCBS) antitrust settlement, health systems like the University of Pennsylvania Health System, MedStar Health, and Geisinger chose not to accept the generic terms applicable to a broad class action settlement. Instead, they opted out of the class action and pursued individual litigation tailored to the specific harm they experienced. Their decisions reflect a larger shift in thinking: as payer behavior becomes more aggressive and reimbursement rates decline, providers are looking for smarter, more strategic paths to healthcare revenue recovery. This shift raises an important question: Should your practice participate in a class action like the Blue Cross class action, or take the path of individual litigation? The answer depends on your healthcare revenue recovery goals, your potential claim value, and how much you want to influence the outcome. This blog outlines the key considerations to weigh as you decide what path makes the most sense for your organization. It is critical to note that class actions often include broad release language that can impact your ability to bring future claims against a payer, even those unrelated to the original harm pursued in the class action. Understanding the full scope of these releases is essential before deciding whether or not to opt out. Consideration #1: How Much Revenue Is at Stake? For many providers, the first and most practical question is: What kind of revenue recovery is realistic? Class actions are inherently broad. They aim to settle disputes for large numbers of claimants at once. That scale often means lower per-claimant payouts. Funds must be divided among all participants, and attorneys’ fees, administrative costs, and settlement terms dilute each provider’s share. The result: a check that may be somewhat easy to claim, but underwhelming in value. Individual litigation involving opting out, by contrast, allows providers to seek revenue recovery based on the full scope of damages relevant to their organization. If your practice has endured years of underpayments, been forced out-of-network, or faced systemic delays and denials, you may have high-value claims that far exceed what a class settlement would yield. In many cases, that gap can amount to millions in additional revenue. For smaller or mid-sized practices, that level of revenue recovery could transform operations. For larger health systems, it could offset years of reduced margins and fund future growth. As reimbursement pressures mount across the industry, the financial opportunity presented by individualized litigation becomes increasingly hard to ignore. Although a class action can result in revenue recovery, it is equally important to focus on the rights which might be lost. Participating in a class action means accepting the settlement’s release language, which can be broader than it appears. In some cases, these releases extend beyond the specific injury at issue, potentially waiving your right to pursue future litigation for related (but still distinct) payer conduct. Failure to opt out may leave your organization locked into terms that handicap future claims. In some cases, the long-term legal consequences of that release can outweigh any short-term payment from the class action. Consideration #2: What Insurer Bad Behavior Is Your Organization Trying to Combat? Class action settlements are designed to resolve large-scale disputes affecting a broad category of harmed individuals and groups. But in doing so, they rarely address the specific behaviors or policy decisions that triggered the issue, or the unique issues that may have affected subsets of the class. The process focuses on compensating the class, not fixing the issues affecting your group. Key Factors That Make Your Case Unique Class settlements often fail to reflect the unique damages your organization may have suffered. For example, the contrast in how physicians vs. health systems are treated, the terms of your direct contracts with the payer—or lack thereof, and the specific impact of insurer practices in your geographic market can all create meaningful differences in harm that class treatment may overlook. Health Systems Vs. Physicians & Physician Groups In the case of the $2.8B BCBS suit, 92% of the settlement proceeds are going towards health systems due to evaluations by the plaintiff’s economists. This means that the affected practitioners and provider groups are left to share only 8%. Therefore, if a physician group is trying to combat insurer underpayments, this particular lawsuit may not be the most fruitful. Contractual Payer Relationships (or Lack Thereof) Organizations with direct contracts in place may have specific rights or limitations based on the terms of those agreements. In contrast, non-participating or out-of-network providers are often left without a clear legal framework for reimbursement. A class settlement rarely captures these nuances, potentially overlooking key differences in payment terms, rate methodology, and enforcement mechanisms. Geographical Market Impact Insurer tactics aren’t always applied uniformly across markets. Your region may be subject to unique practices, such as aggressive downcoding, network tiering, or payment deferrals that aren’t as prevalent elsewhere. Class settlements based on national averages or aggregated harm can fail to account for the concentrated damage in specific geographic areas. Why a Targeted Litigation Strategy? If your organization has been affected by targeted practices, such as delays in pre-authorization, manipulation of payment rates, or algorithmic claim denials, individual litigation gives you the ability to focus on those exact practices and your precise harms. You can craft a case around how those behaviors impacted your business, present specific evidence, and negotiate toward remedies that make sense for your unique situation and goals. This type of tailored litigation also allows for different forms of resolution. Rather than accept the same terms as every other claimant, you can pursue corrective action, policy changes, or operational commitments that align better with your goals. Consideration #3: Could Individual Litigation Yield Greater Leverage or Long-Term Value? Class settlements may resolve overall disputes, but as is often the case, influencing payer behavior is always a challenge. Despite billion-dollar settlements, many insurers continue to engage in the