St. Charles Surgical Hospital, LLC et al vs. Louisiana Health Service & Indemnity Company et al

Case Background

On June 8, 2022, Plaintiff St. Charles Surgical Hospital, LLC and Center For Restorative Breast Surgery, L.L.C. filed an Insurance Underpayment lawsuit in the New Orleans Civil District Court(Case number: 2:19-cv-13497). Judge Sidney Cates presided over the case.

Cause

St. Charles Surgical Hospital and the Center for Restorative Breast Surgery are renowned medical facilities specializing in breast cancer treatment. They provided high-quality medical services to patients insured by Louisiana Health Service & Indemnity Company (Blue Cross Blue Shield of Louisiana), Blue Cross & Blue Shield of Louisiana, Inc., and HMO Louisiana, Inc. The plaintiffs were out-of-network providers with an ongoing business relationship with the defendants. Before performing any procedures, the plaintiffs followed Blue Cross's authorization process, obtaining approvals and verifying that the insurer would pay a fair rate for out-of-network services. However, after the plaintiffs provided care, Blue Cross consistently underpaid them, often remitting only cents on the dollar compared to the billed amounts. This pattern of underpayment persisted for over a decade. Blue Cross engaged in deceptive practices by sending time-sensitive payment documents to patients instead of providers. It concealed internal policies aimed at reducing payments and used contradictory procedures. The insurer targeted the plaintiffs' doctors and patients, pressuring them to use in-network facilities. In some cases, Blue Cross authorized procedures but later denied payment. It claimed these procedures were not medically necessary without notifying the plaintiffs of this change. As the dominant health insurer in Louisiana, Blue Cross used its market power to intimidate and harass the plaintiffs. Its actions formed part of a continuous, systematic, and sophisticated scheme to defraud and harm out-of-network providers, including interfering with claims for out-of-state insureds and systematically underpaying for these services as well.

Injuries

The plaintiffs suffered significant financial harm due to Blue Cross's systematic underpayments and payment delays. Their relationshi