A new ProPublica investigation reveals how some insurers like Blue Cross Blue Shield of Louisiana (BCBSLA) use prior authorization as a delay tactic– approving critical procedures up front to later deny or underpay the claims.
It’s a system designed to delay treatment and burden providers, ultimately jeopardizing patient care.
At the Center for Restorative Breast Surgery in New Orleans, BCBSLA approved breast cancer surgeries, only to ultimately deny or drastically underpay the claims– despite prior authorization. This pattern, which began as early as 2005, affected thousands of procedures and culminated in a $421 million jury verdict against the insurer in 2024.
Between 2015 to 2023, BCBSLA paid less than 9% of the charges billed for more than 7,800 authorized procedures, with many claims not paid at all.
This case underscores how prior authorization can be a profit-driven barrier to care, allowing insurers to approve procedures on paper, then quietly refusing to pay. Previous investigations reveal that this is part of a broader pattern of abuses, where many insurers routinely delay and deny medically necessary treatment, use third-party reviewers to deny care, and underpay and pressure providers to withhold healthcare.
These tactics don’t just put patients at risk, they also force providers to absorb unreimbursed costs, and they contribute to skyrocketing administrative burdens– which now account for more than 40% of hospital operating expenses.
While some insurers claim prior authorization is about reducing wasteful medical spending and unnecessary procedures, prior authorization has evolved into a mechanism for many insurers to line their pockets at the expense of necessary medical care.
At its core, this is about patients’ access to care. Mass denials don’t just hurt patients and doctors – they endanger hospitals and health systems that provide 24/7 care. As these abuses become more common, lawmakers must hold these insurers accountable. Patients deserve care decisions made by doctors, not by insurers driven by profit margins.