07/11/2025
"DellaCroce and Sullivan had repeatedly sued the insurer, alleging that it granted approvals for surgery but then denied payments or paid only a fraction of patients’ bills. They pointed to calls like the one Arch received as proof of the company’s effort to drive away patients. The aggressive legal attack, they knew, was fraught. Litigation against the $3.4 billion company would take a long time and a lot of money. The chances of winning were slight. 'You fight dragons at great peril,' DellaCroce would tell friends. But this September, after 18 years and several defeats in court, jurors found Blue Cross liable for fraud. They awarded the center $421 million — one of the largest verdicts ever to a single medical practice outside of a class-action lawsuit. In a statement, Blue Cross said it 'disagrees with the jury’s decision, which we believe was wrong on the facts and the law. We have filed an appeal and expect to be successful.'
The Blue Cross trial provides a rare opportunity to expose in detail the ways that health insurance companies wield power over doctors and their patients. Blue Cross executives testified that the breast center charged too much money — sometimes more than $180,000 for an operation. The center, they said, deserved special attention because it had a history of questionable charges. But the insurer’s defense went even further, to the very meaning of 'prior authorization,' which it had granted women like Arch to pursue surgery. The authorization, they said in court, recognized that a procedure was medically necessary, but it also contained a clause that it was 'not a guarantee of payment.' Blue Cross was not obliged to pay the center anything, top executives testified. 'Let me be clear: The authorization never says we’re going to pay you,' said Steven Udvarhelyi, who was the CEO for the insurer from 2016 to 2024, in a deposition. 'That’s why there’s a disclaimer.'"
April 12, 2025
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.