re: A $421M jury award against Blue Cross heads to the Louisiana Supreme Court

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If a hospital is not within the network then blaming BC seems to be the wrong party.

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There aren't many details in the article, but it looks like BCBS pre-approved surgeries then refused to pay for them. That's my interpretation, at least.

It's impossible to pick a good guy here.

The patients are the good guys (gals) and the losers.

Feel free to RA.

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The patients are the good guys (gals) and the losers.

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The patients expenses were covered by the hospital. The dispute is over whether Bluecross is liable for the hospitals expense. Which, on the surface, it appears bluecross has a firmer standing on the issue, unless there was some sort of agreement in place by BC to reimburse the hospital. That does not appear to be the case, however.

That’s because we aren’t homeless in need that would rather steal a bicycle than sleep over

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Insurance company people threatening the courts with increased premiums if the case isn't dismissed

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Legal extortion? You don't say.
Insurance companies are the main force behind our medical costs. I hate insurance companies, even though insurance on industrial fixed equipment created my job.

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The LA SC is political. Health insurance is political. Insurance is political.

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None of these things are inherently political.

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The healthcare industrial complex is political.

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You do know you are not forced to have health insurance, right? You are welcome to pay out of pocket for your medical costs.

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Didn't the ACA levy fines against those without insurance?

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Pretty sure all of that went away when Trump dismantled that shitty bill.

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The ACA’s individual mandate still exists on paper—you’re technically supposed to have qualifying coverage—but the Tax Cuts and Jobs Act of 2017 set the penalty to $0 starting with tax year 2019. That has remained the case through 2026. You do not report coverage status on your federal return, and the IRS will not assess a shared-responsibility payment.

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There’s a difference between reconstruction and augmentation.

Someone with breast cancer or whatever else may have to get a mastectomy and insurance should absolutely pay to return it to as normal functioning as possible through reconstruction or whatever. If I had dick cancer that was surgically removed, I’d sure as shite expect my insurance to pay whatever it takes to keep it working and functional.

I haven't read the case, however, it sounds like Blue Cross "approved" the procedure but never agreed to pay the full amount as this particular hospital is "out-of-network." I'm guessing that it paid what it was contractually obligated to pay to an out-of-network provider.

There's a reason why insurance companies only pay a small amount for "out-of-network" providers -- i.e., the provider doesn't negotiate their prices and give a discount (often HUGE) to the insurance company. BUT, this is known in advance.

So, while BC "approved" the procedure, they had no contractual relationship with the provider to pay the full amount requested. BC only had to pay what it was required to pay to an out-of-network provider according to its contract with the insured.

THE REST IS ON THE INSURED. I'm not sure when the "no suprise billing" law went into effect, however, the provider now has a duty to inform the patient how much he/she is going to be called upon to pay.


THE MORAL AND NUMBER ONE TAKE-AWAY from this story is that you should ALWAYS make sure that the doctors and hospitals you visit are all IN-NETWORK with your insurance company. I CHECK EVERY F*CKING TIME I GO TO A DOCTOR OR HOSPITAL and I always ask to get an estimate before I have any procedure done.


There was a news story a few years back on one of the local stations talking about how Tulane Hospital was NOTORIOUS for performing surgeries on patients for which Tulane Hospital and certain Tulane doctors were IN-NETWORK but would assigning out-of-network providers (mostly anesthesiologists) during the procedure. The patient had no idea and just assumed that because they were getting the procedure done at an in-network facility and the personal and doctors would also be in-network. Then a month later they received a bill for thousands for dollars because one or more of the providers were out-of-network.

This is one of the things that led to the "no surprise billing" laws.



ETA: I haven't found the story I saw years ago about Tulane Hospital, however, here's a similar story from 2017 about Tulane Hospital and its ER department...

Tulane SUCKS!!!


Here's a national story about out-of-network anesthesiologist working in in-network hospital....