01/18/2026
In September 2024, a Louisiana jury found Blue Cross and Blue Shield of Louisiana liable for fraud, awarding $421 million to the Center for Restorative Breast Surgery. The lawsuit exposed a systemic practice described by plaintiffs as "slow pay, low pay, or no pay." Despite granting "prior authorizations" for thousands of complex breast cancer surgeries—which doctors and patients interpreted as approvals for coverage—the insurer paid an average of less than 9% of the billed charges. In many cases, the company refused to pay anything at all, leaving the medical center to absorb massive losses or risk patients being saddled with six-figure debts.
The investigation and trial revealed that Blue Cross executives used a "not a guarantee of payment" disclaimer to argue they had no legal obligation to reimburse authorized procedures. Internal documents showed the insurer had placed the breast center on a secret "targeted list" for special scrutiny and created hidden processes to delay and reduce payments. Furthermore, a lucrative "win-win" policy allowed Blue Cross Louisiana to keep a percentage of any "savings" it achieved by underpaying claims from out-of-state patients, effectively incentivizing the company to deny or slash reimbursements.
Beyond the financial manipulation, the company was accused of "moral bankruptcy" regarding its inconsistent standards. While thousands of ordinary patients faced denials and payment hurdles, Blue Cross executives reportedly bypassed their own restrictive rules to sign special "single-case agreements" to ensure full coverage for their own wives' treatments at the same facility. The insurer has denied wrongdoing and is currently appealing the verdict, maintaining that its actions were necessary to keep premiums affordable for its members.
https://www.propublica.org/article/blue-cross-blue-shield-louisiana-insurance-lawsuit-breast-cancer-doctors
Blue Cross authorized mastectomies and breast reconstructions for women with cancer but refused to pay the full doctors’ bills. A jury called it fraud and awarded the practice $421 million.