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A $421M jury award against Blue Cross heads to the Louisiana Supreme Court
Posted on 8/31/26 at 9:09 am
Posted on 8/31/26 at 9:09 am
quote:
Nearly two years after an Orleans Parish jury rendered a $421 million judgment against Blue Cross and Blue Shield of Louisiana, finding the insurer shortchanged a New Orleans surgical hospital on thousands of reconstructive breast surgeries, the Louisiana Supreme Court is preparing to take up the landmark case.
On Tuesday, the state’s high court is scheduled to hear oral arguments in the long-running litigation between St. Charles Surgical Hospital and Center for Restorative Breast Surgery, a privately owned surgical center, and the state’s largest insurer.
In October 2024, a jury ruled that Blue Cross committed fraud by authorizing some 7,800 surgeries from 2015-23 then paying only about 9% of the bills, on average. Blue Cross denied the allegations, arguing that because the hospital is not a member of its provider network, it had no contractual obligation to pay anything.
Earlier this year, the Louisiana Fourth Circuit Court of Appeals overturned the jury award — the highest ever against Blue Cross and among the highest in the state's history — and sent the matter back to the lower court for a new trial.
Both sides in the dispute have since asked the Supreme Court to take up the matter. The hospital is seeking to reverse the Fourth Circuit ruling and reinstate the original judgment. Blue Cross wants the case, which has been litigated twice before, to be dismissed altogether.
The state’s insurance industry is closely eyeing how things play out. In a state known for large jury awards, industry experts say the nearly half-billion-dollar judgment — which, with interest, now tops $655 million, court documents show — could have a chilling effect on the market and potentially drive up premiums.
“Louisiana already faces a property-insurance crisis,” the Louisiana Association of Health Plans said in a “friend of the court” brief filed in the case. “If this Court does not put an end to this litigation and dismiss (the case) once and for all, the State will be on the brink of a health-insurance crisis too.”
James Williams, the hospital’s attorney, declined to comment.
Blue Cross, in a statement, said, “Louisiana Blue has always been confident in its position and appreciated receiving the Fourth Circuit Court of Appeal’s decision reversing the judgment. Throughout this process, we have remained fully committed to improving the health and lives of Louisianians by ensuring access to high quality, affordable care.”
LINK
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Posted on 8/31/26 at 9:14 am to 4cubbies
quote:
In October 2024, a jury ruled that Blue Cross committed fraud by authorizing some 7,800 surgeries from 2015-23 then paying only about 9% of the bills, on average. Blue Cross denied the allegations, arguing that because the hospital is not a member of its provider network, it had no contractual obligation to pay anything.
Healthcare in this country is a joke... for some people. Best care available if you've got cash to spend. If not, well... hope you're in the 9%
Posted on 8/31/26 at 9:14 am to 4cubbies
Insurance company people threatening the courts with increased premiums if the case isn't dismissed. As if premiums wouldn't increase otherwise.
Insurance companies are the least sympathetic victims imaginable.
Insurance companies are the least sympathetic victims imaginable.
Posted on 8/31/26 at 9:16 am to 4cubbies
I am not a fan of big health care insurance but BCBS is generally speaking one of the good ones. I have zero faith that an Orleans jury was capable of comprehending the nuances of the issues at stake. If James Williams is involved it’s likely bullshite:
This post was edited on 8/31/26 at 9:18 am
Posted on 8/31/26 at 9:18 am to 4cubbies
Is "reconstructive breast surgery" the same as breast implants???
If so, why should our tax dollars pay for breast implants?
If so, why should our tax dollars pay for breast implants?
Posted on 8/31/26 at 9:19 am to REG861
I've mostly fought with UHC. NOT ONE OF THE GOOD ONES.
Posted on 8/31/26 at 9:19 am to lake chuck fan
quote:
Is "reconstructive breast surgery" the same as breast implants??? If so, why should our tax dollars pay for breast implants?
It’s for women who have their breast removed relating to cancer and pre cancer surgery .. might want to sit this one out chief.
Posted on 8/31/26 at 9:21 am to lake chuck fan
quote:
Is "reconstructive breast surgery" the same as breast implants???
Breast cancer.
quote:
If so, why should our tax dollars pay for breast implants?
That's not how private health insurance works.
Posted on 8/31/26 at 9:22 am to 4cubbies
quote:
Insurance company people threatening the courts with increased premiums if the case isn't dismissed.
It's not a threat. It's a fact. Insurance companies are not charities. They don't provide health insurance free of charge. If they are to lose a $421M lawsuit, then those expenses will be paid out by the insured and the company.
It's always amazing the people that think insurance companies are bad, who cheer every time a frivolous lawsuit is awarded or settled, and then simultaneously complain about insurance rates.
Litigation is a business expense, and a major one in the insurance world. You can't cheer on the litigious nature of our idiotic populous and also bitch about the cost of insurance. You are literally cheering for your rates to increase.
Posted on 8/31/26 at 9:23 am to 4cubbies
I knew a fella who had set up a re-insurance company offshore that was offering malpractice insurance to doctors in excess of their current coverage. Premiums were minimum 15 grand, minimum policy was 5 million, and the company was brand new.
I asked him about what would happen if you had a claim today while knowing he was just getting started. He did not waste one moment to respond with "By the time we fund the claim, our monthly premium income will be several times higher."
Yep, insurance runs the world!!
I asked him about what would happen if you had a claim today while knowing he was just getting started. He did not waste one moment to respond with "By the time we fund the claim, our monthly premium income will be several times higher."
Yep, insurance runs the world!!
Posted on 8/31/26 at 9:24 am to REG861
quote:
It’s for women who have their breast removed relating to cancer and pre cancer surgery .. might want to sit this one out chief.
Thats why I asked the question Dick Tracy! Smh
Posted on 8/31/26 at 9:24 am to 4cubbies
quote:
shortchanged a New Orleans surgical hospital on thousands of reconstructive breast surgeries
Reconstructive breast surgeries? Seriously?
Posted on 8/31/26 at 9:25 am to BugAC
quote:
It's not a threat. It's a fact. Insurance companies are not charities. They don't provide health insurance free of charge. If they are to lose a $421M lawsuit, then those expenses will be paid out by the insured and the company.
Yes. Every time anyone uses the insurance they pay for, they are causing their rates to increase.
Thanks for explaining insurance to us.
Posted on 8/31/26 at 9:27 am to 4cubbies
quote:
Insurance companies are the least sympathetic victims imaginable.
There’s nothing inherently wrong with insurance companies. The people running them are no more evil and selfish than those in other industries.
It’s the broken system in place that enables and rewards bad behavior.
Posted on 8/31/26 at 9:30 am to lake chuck fan
quote:
Is "reconstructive breast surgery" the same as breast implants???
If so, why should our tax dollars pay for breast implants?
A close family member of mine had a breast removed for cancer treatment in 2001 and was told at that time it was the law that reconstruction was mandated to be covered under insurance. This is not your tax dollars.
Posted on 8/31/26 at 9:37 am to GetmorewithLes
quote:
This is not your tax dollars.
Oh yes it is
Plenty of medicaid patients also get breast reconstructions after cancer
Posted on 8/31/26 at 9:43 am to atlgamecockman
Why do premiums have to rise? Why can't billions in profit suffer?
Posted on 8/31/26 at 9:44 am to 4cubbies
If a hospital is not within the network then blaming BC seems to be the wrong party. SCH could have joined the network but then their exorbitant pricing would be revealed. They prey upon people that are at their lowest point
Posted on 8/31/26 at 9:45 am to 4cubbies
quote:
Yes. Every time anyone uses the insurance they pay for, they are causing their rates to increase.
Thanks for explaining insurance to us.
Well, clearly you don't understand, when you are claiming
quote:
Insurance company people threatening the courts with increased premiums if the case isn't dismissed.
So, here are some facts about the case that nola.com, is of course, leaving out.
quote:
The New Orleans-based hospital and center, founded by surgeons Frank DellaCroce and Scott Sullivan, specialize in autologous tissue breast reconstruction after mastectomy. They left the Blue Cross network in 2007 over reimbursement rates and have since operated as out-of-network providers. They continued treating Blue Cross patients after receiving prior authorizations that the procedures were medically necessary.
quote:
From 2015 to 2023, they billed for roughly 7,800 such procedures. Blue Cross paid about 9% of the billed amounts on average; many claims received no payment. The hospital alleged it did not balance-bill patients and absorbed the shortfall.
quote:
Blue Cross argued it had no contract with the out-of-network provider and thus no obligation to pay billed charges. Authorization confirmed medical necessity only; reimbursement for out-of-network care is not a fixed rate and can be far below billed amounts. The insurer also pointed to two earlier similar suits by the hospital that were dismissed in federal court.
quote:
Trial and verdict
The case was filed in Orleans Parish Civil District Court around 2017 (the third attempt after prior dismissals). After a three-week trial in September 2024 before Judge Sidney Cates IV, a jury awarded the hospital $421,488,633—the unpaid billed amount calculated by the hospital’s damages expert. Deliberations lasted under two hours. The award did not include punitive damages or attorney fees. The hospital said it intended to use any recovery to cover patient balances.
The trial judge later denied Blue Cross’s motion for a new trial.
quote:
Blue Cross appealed to the Louisiana Fourth Circuit Court of Appeal. In January 2026 the court reversed the judgment and remanded for a new trial. It held that the jury instructions on fraud omitted an essential element of the claim and that the jury form was inadequate, so the verdict carried no weight. The court declined to resolve the merits itself given the case’s complexity and scale.
FWIW, i'm not advocating for/against one or the other. I've had family that has gone to that particular hospital and they do a wonderful job. It appears, though, that someone made assumptions and it may cost them. There is a grey area here that isn't being reported, and it looks like the Nola judicial system is creating a mess out of this, even moreso, than it would have been under a competent judiciary.
This post was edited on 8/31/26 at 9:47 am
Posted on 8/31/26 at 9:45 am to atlgamecockman
quote:
Healthcare in this country is a joke... for some people. Best care available if you've got cash to spend. If not, well... hope you're in the 9%
Or be an illegal immigrant.
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