As best I can tell, this surgery center is charging 2x to 4x the price for breast reconstruction as other centers ($42k per claim per the article). Yes, it's an advanced center with new techniques, but are they really providing an extra $20k-$30k in value? I don't know the answer to that, just posting the numbers because it's not a matter of a small difference in pricing.
Does the policy in question have a "usual, customary and reasonable"[1] clause? If so, charging 2-4x would obviously give the insurance company grounds to deny the claim.
But, could this be an interesting inflection point, where rich doctors and even richer executives of insurance companies are now starting to eat each other.
