Insurance chief calls for end to UMMC and Blue Cross dispute

Mississippi Insurance Commissioner Mike Chaney penned a letter Thursday urging the state’s largest hospital and insurer to use the same mediation process it used to settle their contract dispute in 2018.

Chaney told Mississippi Today that the state’s Department of Insurance will address concerns about patient access to the organ transplant unit and children’s hospital at the University of Mississippi Medical Center, services that cannot be found elsewhere in the state.

Chaney said he could not specify how his office would address those concerns due to state privacy laws.

The hospital and Blue Cross and Blue Shield of Mississippi have not communicated since April 1, when UMMC officially disconnected from the network with the insurance company, according to officials from both entities. Tens of thousands of Mississippians — some critically ill and others needing advanced specialties only available at UMMC — are stuck in the middle of the conflict.

“While UMMC and BCBSMS appear to be even further apart today than in 2018, I strongly believe that the parties can once again find common ground that recognizes and reflects UMMC’s unique role in as an Academic Medical Center of Mississippi while respecting BCBSMS’ vital role in maintaining affordable coverage for its enrollees,” says Chaney’s letter to Dr. LouAnn Woodward, Vice Chancellor for Health Affairs and Dean of UMMC School of Medicine, and to Carol Ann Pigott, CEO of BCBSMS.

“We are open to mediating between the state’s only academic medical center and the largest insurer, which is in the best interests of our current and future patients and the Mississippi health system,” said Marc Rolph, UMMC’s Executive Director of Communications and Marketing. statement.

BCBSMS said it would not comment on the matter before responding directly to Chaney’s letter.

Chaney gave both an April 27 deadline to respond to his recommendation. Regardless of whether the parties agree to mediation, the Department of Insurance will address concerns that UMMC exiting the network with BCBSMS violates state network adequacy regulations by denying access. from the patient to medical services that cannot be found elsewhere in the state, Chaney said in an interview with Mississippi Today.

“While we hope we will have mediation, we will also address the adequacy of the network regarding Blair Batson Children’s Hospital and the transplant unit,” Chaney said.

BCBSMS argues that even without UMMC, it still meets its network adequacy requirement. BCBSMS also said that the remedy in a situation where network adequacy is an issue is for it to provide network-level benefits to its customers for these services, which it proposed to do by asking its members to sign a written payment instruction asking the insurer to pay the hospital.

UMMC refused to accept these payments from BCBS, arguing that this would allow BCBSMS to continue paying at unsustainable rates.

Although the two parties have had similar contract disputes in previous years, this is the first time that UMMC has been removed from BCBSMS’ network.

As a result, tens of thousands of Mississippians have had to face higher medical bills or seek care elsewhere. Potential transplant recipients who have spent months or years on waiting lists for organ donations have been put on hold. Parents of children who need specialized care that can only be provided at UMMC Children’s Hospital are left with expensive and inconvenient options for continuing their child’s care.

UMMC has the only organ transplant center in the state in addition to the only children’s hospital, level I trauma center, level IV neonatal intensive care unit and other advanced specialties.

The arbitration process Chaney recommended in the letter was used by both parties in 2018 and involves bringing in an expert, impartial mediator who can preside over new contract negotiations. UMMC requested the same increases to its reimbursement rates in 2018 that it is requesting now, but through a mediator, the two sides reached an agreement that did not increase rates.

Instead, Blue Cross agreed to remove language that made the contract permanent, meaning the insurance company could no longer change the terms of the contract at any time.

If both parties agree to mediation, a deadline will be set for them to resolve their differences, Chaney told Mississippi Today. The deadline will likely be June 1 – 30 days before the end of the 90-day “continuity of care” period, where some BCBSMS patients can still receive care at UMMC and have their insurance accepted.

According to state agency rules, Chaney is not allowed to directly arbitrate or settle disputes regarding contacts between insurance companies and health care providers, but in the letter, Chaney said that he could recommend a mediator if both parties accepted the proposal.

The dispute between the UMMC and the BCBSMS stems from a disagreement over reimbursement rates and Blue Cross’s quality care plan, which measures the hospital’s performance and whether the services provided to patients are adequate.

UMMC is asking Blue Cross for substantial increases in reimbursement rates for inpatients, outpatients and professionals, some as high as 50%. Blue Cross’s overall reimbursement would increase by approximately 30% in the first year of the new contract.

Mississippi has the lowest commercial insurance company reimbursement rate for inpatient services in the nation, according to a 2021 white paper by the actuarial and consulting firm Milliman.

While UMMC argues that BCBSMS pays them well below market rates for other area academic medical centers, BCBSMS argues that accepting the increases would require significant premium increases for their clients.

BCBSMS & UMMC – Request… by William Stribling

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