Doctors win $421M lawsuit after insurer denies payment for approved surgeries.
In 2017, Witney Arch felt a sharp pain in her chest after her toddler accidentally hit her breast. At first, she brushed it off. But the pain didn’t fade, and after a series of doctor visits and tests, she was diagnosed with early-stage breast cancer. Her medical team warned it could be aggressive, and by the start of the new year, she had made two big decisions: she would undergo a double mastectomy, and she would do it at a facility in New Orleans known for helping women recover not just physically but emotionally—The Center for Restorative Breast Surgery. Her insurer, Blue Cross and Blue Shield of Louisiana, gave her the green light to go ahead with the surgery, which is called prior authorization. That should have meant less to worry about. But just days before her operation, she got a phone call that changed everything. Someone from Blue Cross called to suggest she go somewhere else, saying the surgery was too expensive at that particular center. Arch stuck to her plan. She had faith in her doctors. Over the next year, she went through five surgeries, but what she didn’t know at the time was that her case would end up at the center of a years-long court fight.
The two surgeons who founded the center, Dr. Frank DellaCroce and Dr. Scott Sullivan, had been battling the insurer Blue Cross for years. They claimed the insurance company promised to pay for procedures, then didn’t—either paying only part of the bill or nothing at all. The surgeons said the company used calls like the one Arch received to try and push patients away. Documents and testimony later revealed something deeper: a pattern of behavior where the insurance company played both sides—setting the rules and deciding the outcomes.
In Louisiana, Blue Cross is the dominant insurer, with the vast majority of doctors and hospitals under contract. But DellaCroce and Sullivan never agreed to be part of that network. They said the payments Blue Cross offered wouldn’t even cover their costs. So their center remained out-of-network, meaning they charged full price. Blue Cross, in turn, decided what it would pay—and those amounts were usually far lower.
When the doctors sued, they discovered internal documents showing they had been put on a special list as far back as 2007. Their cases were flagged for extra scrutiny. Every bill they sent in was picked apart manually. They were also on a “blocked” list, which meant even if their patients got prior authorization, Blue Cross might still not pay.
In 2024, after nearly two decades of legal fights, the case finally went to trial. The center’s lawyer warned the jury to pay attention to the big picture, not just insurance lingo. Over 10 days, the trial laid bare how appeals filed by the center were never reviewed. When asked why, a Blue Cross executive admitted that underpayment appeals weren’t something the company looked at.
The jury sided with the center. They awarded the doctors over $421 million in damages, saying the insurance company had defrauded them. One juror even said they would have awarded more if asked. After all the years, surgeries, and paperwork, Arch’s painful story ended up helping bring a hidden conflict into the light—a conflict about who really controls health care decisions, and how far companies will go to protect their bottom line.
Sources:
Blue Cross Defrauded Breast Cancer Center, Must Pay $421M, Jury Finds
How two New Orleans surgeons challenged an insurance giant’s reluctance to cover patients’ bills
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