Cory Doctorow
A jury has ordered Blue Cross of Louisiana to pay $421m to a hospital specializing in a much sought-after type of breast reconstruction, primarily for cancer survivors. The insurer "preapproved" surgeries for thousands of patients, but then held back 92% of the payments it owed, with CEO Steven Udvarhelyi insisting that "authorization never says we’re going to pay you":
https://www.documentcloud.org/documents/25882446-steven-udvarhelyi-deposition/#document/p1/a2630959
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Cory Doctorow
In a characteristically brilliant and deep investigative story, *Propublica*'s T Christian Miller explains how Blue Cross of Louisiana colluded with other Blue Cross franchises around the country to steal hundreds of millions of dollars by denying claims they'd already approved:
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Cory Doctorow
If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:
https://pluralistic.net/2025/04/12/pre-authorization/#is-not-a-guarantee-of-payment
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Cory Doctorow
Blue Cross's official excuse for denying the claims was that it was acting in the best interest of the millions of Louisianans it insures: *DellaCroce and Sullivan are simply too expensive - it's not realistic for people in an insurance pool to expect that kind of care*. However, Blue Cross executives repeatedly signed one-off, "single case agreements" so that their own wives could get the procedure from DellaCroce and Sullivan.
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Cory Doctorow
Rather than throwing their patients into the Blue Cross meat-grinder, DellaCroce and Sullivan carried the unpaid balance on its books, repeatedly suing Blue Cross for the unpaid amount. Finally, last week, the a jury ordered Blue Cross to pay $421m to the hospital (Blue Cross is appealing).
The case dragged Blue Cross's sleazy behavior - normally confined to bureaucratic memos and telephone denials - into the public, and *boy* is it ugly.
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Cory Doctorow
Accordingly, patients seek pre-approval from their insurer before undergoing the procedure, and in Louisiana, that usually means calling up Blue Cross, the state's largest insurer. Despite pre-approving the procedure, Blue Cross of Louisiana has held back over 90% of the payments it owed to the hospital.
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Cory Doctorow
While other surgeons perform this surgery, DellaCroce and Sullivan are acknowledged as national leaders, having invented many innovative techniques and trained many of the other surgeons who perform the procedure. As a result, patients travel from all over America to the Center for Restorative Breast Surgery.
DellaCroce and Sullivan's procedure is extremely precise and labor-intensive, and it comes at a high cost.
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Cory Doctorow
The hospital at the center of this controversy is the Center for Restorative Breast Surgery in New Orleans, founded by two surgeons, Frank DellaCroce and Scott Sullivan. DellaCroce and Sullivan are pioneers of an advanced form of breast reconstruction called "autologous tissue reconstruction," which eschews implants in favor of the patient's own fat to construct new breasts.
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