Judges on the 11th Circuit U.S. District Court of Appeals have upheld a historic $2.67 billion settlement in a long-running antitrust case against health insurance giant Blue Cross Blue Shield.

Three years ago, a federal judge in Alabama approved a massive settlement to be split among attorneys and customers who had been hurt by the company’s anti-competitive practices. Those claims have been held up by challenges to the settlement.

Those challenges included concerns that the settlement could prevent the federal government from enforcing antitrust law against the company and that attorneys on the case earned too much. Judges on the appeals court in Atlanta dismissed those and other challenges in late October.

The case started in 2013 after customers claimed that Blue Cross plans had violated antitrust laws by improperly divvying up territory and agreeing not to compete. Claims against several different Blue Cross affiliates were consolidated in Alabama.

The $2.67 billion settlement is one of the largest ever approved for a healthcare case. A website has been set up to help people who are following the case.

The window for filing a claim in the case has closed. Parties who want to challenge the settlement still have time to appeal again in the first quarter of 2024.