I’ve been reporting on health insurance denials for more than a year. Last fall, I stumbled across a lawsuit that, with interviews, revealed one insurers’ playbook of secret lists, special deals and lowball payments. 👇
Comments
Log in with your Bluesky account to leave a comment
Genuinely interested to see if this leads to further exposure across the insurance / health system. Prior authorizations say that a procedure is medically necessary. Creates a false since of hope that it will be covered once it actually happens and a claim is then made.
Meet Witney Arch, a 42-year-old mom of four. When she found out she had breast cancer, she decided to go to the Center for Restorative Breast Surgery in New Orleans, renowned for its highly specialized approach to post mastectomy breast reconstruction.
Blue Cross gave her prior authorization. Then things got strange. A little before the operation, a representative called to try to convince her to go somewhere else: “Do you know how much this is going to cost?”
Witney wasn’t the only patient who got pushback. Founding surgeons Frank DellaCroce and Scott Sullivan had battled @MyLouisianaBlue in court for 18 years over payments for surgery that Blue Cross agreed was medically necessary.
The crux of the case: Blue Cross had approved more than 7,800 procedures related to mastectomies and breast restorations. But it paid only about 9% of the bills for those treatments. And sometimes nothing at all. In fact, 60% of the claims were zero pay.
That’s what I thought. But after enrolling in Medicare— and the AARP endorsed United Healthcare Supplemental and RX plan —I can attest that UHC is slow walking everything and routinely and repeatedly denying necessary drug coverage.
We need better than that. Paying 180 or 350 in retirement after paying into our whole working life, while also paying our own insurance premiums. That plus drugs, etc. too much
Similar thing just happened to me. BCBS authorized chemo (totaling ~$150K) I had at PennMed 10/23-3/2024, Just received letters that they are refusing to pay.
It's an A1 (not AI) excellent piece. It makes a solid case for the elimination of medical insurance altogether and a case for universal Medicare (single government payer).
We do not need insurance companies. Doctors don't get paid the whole over charging so they might get paid something is so confusing and that is without even going through the authorization process that someone sitting at a computer decides who gets lifesaving care.
And yeah their strategy is deny, deny, deny. They disputed about $63 of an $8,000 charge and I fought it tooth and nail because I was so angry. I spent hours and hours (at work, to be fair) on it.
I won.
It was worth it.
BC is the worst! When I worked in that world, their premiums were cheaper than ours, but it was because they paid at only about 60% of R&C. We paid at 90%.
Are you referring to a HMO or PPO? I have had BCBS of TX PPO for about 10 years and I am fortunate enough to not use it often, yet when I do it pays every time.
interesting information here, hopefully this gets resolved and the news catches this. If this is yours, have you contacted the news and seen if they would help or write up a story on this??
My news stations do stuff like this.
Thank you for this amazing reporting! We nee more of this. My insurer refuses to authorize my treatment for Stage IV cancer. They just stopped authorizing it. They play so many games it's overwhelming and exhausting.
Comments
Sludge is deliberate.
I won.
It was worth it.
My news stations do stuff like this.