The movement to hold U.S. health insurance companies accountable is most prominent in Louisiana, where a civil court jury recently found that it underpaid insurance to a surgical center that often treats cancer patients. Reached notable legal victory by ordering health insurance company to pay more than $400 million.
But on appeal, Louisiana insurer Blue Cross Blue Shield (BCBS) seeks to reduce, if not eliminate, the jury's award against St. Charles Surgical Hospital and Breast Restorative Surgery Center. He clarified. BCBS could seek relief from both the state's Fourth Circuit Court of Appeals and the Louisiana Supreme Court.
Nevertheless, the hospital's co-founders called the Sept. 20 ruling in their favor “all those who have felt bullied by big corporate health insurance and their self-serving behavior. It was hailed as a “groundbreaking” victory for the country.
“We worked long hours, pioneered progress, and cared for these women. And we fought back for our frontline workers and the patients who depend on them.” Dr. Delacroce said. said WDSU, New Orleans NBC affiliate.
As a New Orleans CBS affiliate WWL Louisiana He noted that surgeons at the hospital that Delacroce co-founded with Dr. Scott Sullivan sued BCBS in 2017, alleging that the insurance company did not cover 9,000 licensed surgeries over a 10-year period.
“Blue Cross either doesn't pay all these bills, or they don't,” said the hospital's lead attorney, James Williams of the New Orleans-based law firm Chehadi Sherman Williams. told WWL.
St. Charles Surgical Center, named after the famous New Orleans street on which the center is located, dropped out of the BCBS insurance network prior to the dispute. Williams argued that BCBS' failure to pay compensation was designed to pressure facilities to join its network, which includes the majority of Louisiana health care providers.
As reported by the New Orleans Times-Picayune, the insurer countered that approval of the procedure did not mean payment was guaranteed. reported. However, the jury ultimately ruled 11-1 that BCBS owed the hospital more than $421 million in reimbursement for unpaid claims.
St. Charles Hospital was only seeking a full refund of unpaid insurance claims. The doctors say they refuse to pass on the uncovered surgical costs to patients and plan to use the jury's award to pay off patients' remaining balances.
BCBS issued a statement to multiple media outlets saying it “strongly” disagrees with the jury's decision, which was one of the largest awards in Louisiana history. The company said in a statement that it expects such a ruling, if left unaddressed, will lead to higher premiums. Ta.
“We will promptly appeal the case and expect to win,” the insurance company said in a statement.
Meanwhile, the CEO of the Louisiana insurance industry trade association echoed BCBS' position. Jeff Drozda of the Louisiana Health Plans Association told WDSU that if the ruling stands, health insurance companies will be forced to pay “out-of-network, non-negotiating providers…whatever they want to charge.” He said it would be.
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“With any health plan, there will be other providers across the state … looking at opportunities to make similar claims for reimbursement,” Drozda told the station.
As for the plaintiffs, Matthew Sherman, a partner at Williams, told WDSU, “The jury's finding of misconduct… shows that the legal system will not tolerate it.” [BCBS] Louisiana needs to put its own self-interest ahead of the patient's. ”
“Doctors and patients have a right to expect” [BCBS] The State of Louisiana requires us to honor our promise to provide fair and accurate payment for services. ”
The United States is the only wealthy democracy without universal health care, and Americans rely primarily on employer-sponsored private health insurance provided by companies such as BCBS.
