As best I can tell, this surgery center is charging 2x to 4x the price for breast reconstruction as other centers ($42k per claim per the article). Yes, it's an advanced center with new techniques, but are they really providing an extra $20k-$30k in value? I don't know the answer to that, just posting the numbers because it's not a matter of a small difference in pricing.
Does the policy in question have a "usual, customary and reasonable"[1] clause? If so, charging 2-4x would obviously give the insurance company grounds to deny the claim.
https://en.wikipedia.org/wiki/Usual,_customary_and_reasonabl...
The American healthcare industry is scammers and upsellers all the way down
But, could this be an interesting inflection point, where rich doctors and even richer executives of insurance companies are now starting to eat each other.
I think this is just one of the downsides of being among the most hated industries in the US... juries are made of people you've inevitably screwed before.
Guy from fight club voice:
See, X is the amount we make every time we screw somebody. We multiply X by the probability that they will end up in a jury against us, and we multiply that by the average award, and if the amount is smaller than X, we continue to screw.
I like the subtle threat at the end where Blue Cross says they'll punish Louisianans for this.
That's how insurance companies are supposed to work? The current price they were charging was presumably based off the assumption that they didn't have to pay 2-4x more for "advanced surgeries". If as a result of this court case it turned out they did, you'd expect prices to go up. It's not any different than insurance companies raising prices after a major disaster.
Yeah, can't have this eat into their profits.
in 2023 BCBS had an operating margin of 1% in one of the states i looked at, 0% in another, in california seems to be around 2%. they don’t operate with crazy profits, and insurance is HEAVILY regulated anyway.
i expect better from HN
> “They even kept a log of the G-file savings from Drs. Sullivan, DellaCroce, and Trahan, and that goes right to the bottom line in profit,” said Dr. Sullivan.
BCBS Louisiana is a mutual insurer, so the “profits” would be lower premiums for insureds, absent embezzlement by the BCBSLA leaders.
Not that BCBSLA leaders are innocent of any wrongdoing, but just an FYI that it it is not a typical business with shareholders.
They also just had a merger attempt torpedoed by the state legislature
How much should medical procedures cost?
Blue Cross Blue Shield of Louisiana is a $2.5 Billion dollar company
From their website:
>Founded in New Orleans in 1934, we are a tax-paying not-for-profit health insurer with offices in every major region to serve our customers.
What does it even mean for a non-profit to be "$2.5 Billion dollar company"?