"Slow Pay, Low Pay or No Pay": Blue Cross Approved Surgeries Then Refused to Pay

Summary

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. Reporting Highlights Shortchanged: Blue Cross Louisiana OK’d mastectomies and breast reconstructions for women with cancer but refused to pay a hospital’s full bills. For some claims, it paid nothing. Exceptions: Blue Cross denied payments for thousands of procedures involved in breast reconstruction. But it approved special deals for treatment for executives’ wives. Verdict: A jury found Blue Cross liable for fraud and awarded the hospital $421 million. The insurance company denied wrongdoing and has appealed. These highlights were written by the reporters and editors who worked on this story. On a late afternoon in November 2017, Witney Arch told her 1-1/2-year-old son to stop playing and come inside. Upset, he grabbed her right breast when she picked him up. She experienced a shock of pain but did not think it was anything serious. A week later, however, the ache had not subsided. After trips to several doctors, a biopsy revealed that Arch had early-stage breast cancer. Her surgeon told her that it was likely invasive and aggressive. By the end of January, she had made two critical decisions. She would get a double mastectomy. And she wanted her operation at the Center for Restorative Breast Surgery in New Orleans, a medical facility renowned for its highly specialized approach to breast cancer care and reconstruction. The two surgeons who founded it had pioneered techniques that used a woman’s own body tissue to form new breasts post mastectomy. The idea of a natural restoration appealed to Arch. “I don’t judge anybody for getting implants, especially if you’ve had cancer,” she said. “But I felt like I was taking something foreign out of my body, cancer, and I did not want to put something foreign back in.” Arch was a 42-year-old preschool teacher for her church, with four young children, living in a suburb of New Orleans. Th...