St. Charles Surgical Hospital and Center for Restorative Breast Surgery, a New Orleans-based surgical center, has been awarded $421 million in damages from Blue Cross Blue Shield of Louisiana. According to NOLA.com, the jury found the insurance giant guilty of shortchanging the health center for breast reconstruction surgeries, spanning a period from 2015 to 2023.
Matthew Sherman, the attorney for the surgical center, accused Blue Cross of employing delay tactics to avoid trial, as reported by WGNO News. He said, "Blue Cross tried to pretty much use any type of delay tactic they could to avoid having this trial in Orleans Parish, state court, which is where we ultimately tried the case." The jury's unanimous verdict came after less than two hours of deliberations, following a three-week trial.
Coverage from WWLTV.com highlighted the struggle faced by patients like Witney Arch, a breast cancer survivor who opted for surgery at the center. She reported being pressured by Blue Cross to choose in-network, presumably less costly, physicians. "I was not going to go anywhere else, because these are the doctors that are pioneers in this industry, and they teach other surgeons around the world how to do my very surgery," Witney Arch explained to Blue Cross.
Despite the ruling, Blue Cross has expressed its intention to appeal the verdict. "While we appreciate and value the legal process, we strongly disagree with the jury’s verdict. We will quickly appeal and expect to be successful," according to WGNO News. The case underlines the contentious relationship often seen between healthcare providers and insurers, with reimbursement rates and network status frequently at the core of disputes.
The lawsuit's outcome could have major effects on healthcare providers and insurers in Louisiana and possibly beyond. Kim Sport, founder of the Breastoration Foundation and President of the Cancer Association of Louisiana, notes that insurers are increasingly motivated to steer patients away from advanced surgical procedures. "We have seen a trend nationwide, and by insurers in the state of Louisiana, to try to discourage or disincentive access to these advanced surgeries to women that need reconstruction following their mastectomy," Sport told WWLTV.com.
