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

Outrage at insurer behavior and “prior authorization”

• Many readers fixate on the insurer’s claim that prior authorization is “not a guarantee of payment,” seeing it as outright bad faith when approvals are followed by aggressive underpayment or denial.
• Commenters are especially incensed that executives arranged “single case agreements” so their own family members could get top-tier out‑of‑network care, while ordinary patients were blocked or underpaid.
• Some note the technical rationale for disclaimers (deductibles, lapsed coverage) but argue this was clearly stretched beyond that to systematically avoid paying.

Expectations of care vs system affordability

• Several people question whether it is reasonable to expect insurance to cover the most prestigious or “pioneering” surgeons and clinics when cheaper, standard reconstructions exist.
• Others counter that insurance should make the patient’s choice of competent provider largely irrelevant, and that executives’ willingness to use the expensive clinic for their own families undercuts “it’s too costly” defenses.
• There is debate over whether US patients overvalue brand‑name credentials vs actual competence, contributing to huge pay stratification among doctors.

Structural problems: pricing, intermediaries, employer plans

• Commenters describe opaque, wildly variable pricing, multiple “list prices” (cash vs insured vs denied‑then‑self‑pay), and hours of administrative fighting as core failures.
• Some argue hospitals’ inflated charges are the root problem; others note insurers now own major cost centers (physician groups, pharmacies, PBMs) and profit from both sides of the transaction.
• Employer‑based, self‑insured plans are blamed for offloading cost‑cutting pressure onto insurers while keeping workers captive; many advocate decoupling insurance from jobs and moving to some form of single payer or at least tax‑funded catastrophic coverage.

Politics, populism, and foreign influence

• The story is used as an example of why voters turn to “strongman” or anti‑establishment candidates out of desperation, even when those candidates openly support the same corporate interests.
• There is back‑and‑forth over whether foreign propaganda (especially Russian) meaningfully drives polarization, or merely exploits existing systemic failures and a rigid two‑party system.
• Some suggest alternative voting systems (score or proportional voting) as ways to break duopoly capture and enable genuine reformist movements.

Violence, despair, and legitimacy of the system

• The recent assassination of a health‑insurance CEO is extensively debated: some label it “criminal insanity”; others see it as a predictable, if unjustifiable, reaction from people denied life‑saving care.
• Several warn that normalizing or glorifying such violence invites copycats and deeper chaos, while others argue the system already inflicts lethal harm by denying care.
• There is visible nihilism: talk of civil war, revolution, or mass emigration; claims that corporate capture and legalized bribery leave no peaceful route to serious reform.

Individual coping strategies and proposed remedies

• Personal anecdotes describe surprise five‑ and six‑figure bills after prior authorization; some won relief only by involving state regulators, negotiating as cash payers, or simply refusing to pay and betting on weak collections.
• Suggested systemic fixes include:
  • FDIC‑style takeovers that wipe out health‑plan leadership after major abuses.
  • Penalties as forced government equity stakes rather than fines.
  • Stronger state and federal oversight, including of the Blue Cross association itself.
• A minority believes the commercial insurance model is in “early death throes” and may collapse under its own contradictions, though others see no clear path to a better US system from here.