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

Posted by 4cubbies

Member since Sep 2008

62915 posts

Posted on 8/31/26 at 12:51 pm to Lsupimp

I hate everything about all of that! I would like to adopt you so you can be a dependent on my policy.

Posted by Lsupimp

Ersatz Amerika-97.6% phony & fake

Member since Nov 2003

86590 posts

Posted on 8/31/26 at 12:52 pm to SlowFlowPro

You should look into this GHOST NETWORK issue. They sent me an EOB with 50 some orthopedists, none of who will accept payment. That includes the BROC and Ochsner.

quote:
Ambetter in Louisiana is offered through Louisiana Healthcare Connections, a major provider of Medicaid and Marketplace plans in the state
Ambetter
Ambetter
+1
. These plans are Marketplace-certified Qualified Health Plans, designed to provide high-quality, locally-based healthcare services with coordinated care programs
eHealth
eHealth
. Ambetter is available in select parishes, and coverage can include optional vision and dental benefits, as well as access to mail-order pharmacy services

Ambetter is part of Centene Corporation, a Fortune 500 company with extensive experience in managed care and specialty health solutions
eHealth
eHealth
. Members benefit from enhanced collaboration with providers, strategic care coordination, and access to wellness programs. Ambetter also emphasizes local, community-based resources to support members’ health and wellness goals

Posted by Lsupimp

Ersatz Amerika-97.6% phony & fake

Member since Nov 2003

86590 posts

Posted on 8/31/26 at 12:53 pm to 4cubbies

Thank you, Cubbies, and I have no doubt you would if we lived in a world where it was possible.

Posted by SlowFlowPro

With populists, expect populism

Member since Jan 2004

481517 posts

Posted on 8/31/26 at 12:56 pm to Lsupimp

Is this one of those plans that were created as an alternative to the marketplace? It's not one of the Christian ones, is it?

Posted by soonerinlOUisiana

South of I-10

Member since Aug 2012

2806 posts

Posted on 8/31/26 at 12:57 pm to 4cubbies

quote:
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.

This post reflects a fundamental ignorance of the concept of insurance. The whole purpose of insurance is to spread the loss over the entire risk pool. Yes, it is form of collectivism.

Posted by Lsupimp

Ersatz Amerika-97.6% phony & fake

Member since Nov 2003

86590 posts

Posted on 8/31/26 at 1:01 pm to SlowFlowPro

Geaux get em, Tiger!

quote:
Ambetter from Louisiana Healthcare Connections is a Centene-affiliated insurer offering ACA Marketplace plans to Louisiana individuals and families. Its plans are underwritten by Ambetter Health of Louisiana, Inc.
ambetterhealth.com

It is a major statewide-market competitor: Centene held about 26% of Louisiana's individual insurance market, covering roughly 65,000 people in the cited market data - second only to Louisiana Health Service/Blue Cross.

Among Louisiana Marketplace plans, Ambetter is especially competitive on price. NerdWallet's 2026 comparison rated it 4.5 out of 5 and named it Louisiana's most affordable option, although that is an editorial rating rather than an official government ranking. Six insurers offer Louisiana Marketplace coverage in 2026.

Posted by notiger1997

Metairie

Member since May 2009

61852 posts

Posted on 8/31/26 at 1:10 pm to REG861

quote:
It’s for women who have their breast removed relating to cancer and pre cancer surgery .

My wife went there for breast removal and reconstructive surgery after two rounds of breast cancer.
Because of the radiation she had received, silicone implants weren’t possible so they used hip, stomach, and but muscle/fat.

The staff were amazing and I think one of the doctors is considered somewhat of a pioneer in this kind of surgery.
We could have went with a fully covered by Blue Cross facility, but I paid the $16k out of pocket I needed to so she could be with the best possible surgery facility.

Posted by Diamondawg

Mississippi

Member since Oct 2006

39545 posts

Posted on 8/31/26 at 2:07 pm to MikeD

quote:
Sounds like they got treated, and the hospital ate the charges. The patients don't sound like losers to me.

I would bet the hospital tried to collect balance not paid through their own patient accounting and then turned over to a collector on long term debt. Some, I'm sure there was some "bad Debt" (they know they will never collect) that was just written off. If they lost that much money over ever how many years by pushing the envelop, no less the the Administrator, CFO and Patient Accounts Director should be looking for work.

Posted by MMauler

Primary This RINO Traitor

Member since Jun 2013

24775 posts

Posted on 8/31/26 at 2:33 pm to Lsupimp

quote:
AmBetter -then sent me a list of orthopedic surgeons with about 50 names-none of whom will accept AmBetter.

A friend of mine asked me to help him navigate the ACA portal. I put in his information and spent a lot of time looking at all the different plans. I had never heard of Ambetter but they had several plans that looked promising. Both Ambetter and UHC definitely offered the least expensive plans.

When I looked further into both, I found out that they were very lowly rated. The denial rates are obscene. It was rare to find a good review from patients. I told him he’d be better off just sticking with a Blue Cross plan and paying the extra cost. I also told him to stay away from the EPO plans and stick with a PPO or POS plan. The PPO were much more expensive but seemed easier to use.

In the end, he got a Blue Cross POS plan that cost him a little more but so far has approved everything he’s needed. He definitely makes sure to stay in-network per my strong recommendation.

This post was edited on 8/31/26 at 2:38 pm

Posted by tigercross

Member since Feb 2008

5076 posts

Posted on 8/31/26 at 2:54 pm to I-59 Tiger

quote:

I guess this is a 'BCBS' post within another thread. Doctor prescribed Jardiance around Christmas last year. Company I worked at the time was HQ in SC so we had 'Blue Cross of South Carolina.' No problem. Left them in May for another job so had to go on the Mrs insurance for a month. She had Blue Cross of Alabama.' No problem.

New company I'm at has 'Anthem' some other BCBS identiy. Jardiance "denied." I don't get it.

Your prior employer negotiated with BCBS to have Jardiance on the formulary, your current employer did not.