Blue Cross Blue Shield Does Not Contract With Maimonides
A contract dispute over reimbursement rates between the University of Mississippi Medical Center and Blue Cross Bluish Shield of Mississippi has resulted in the hospital going out of network today, April 1. This movement volition cause a serious spike in the cost of health-care services for customers of one of the country's largest insurers at Mississippi's largest public hospital organisation.
Out-of-network charges are often prohibitively expensive, with insurance providers paying significantly less of the agreed-upon rate, and with additional charges passing on to the patients. Patients who use out-of-network medical services can normally wait to pay thousands of dollars more for care than those who seek handling in the network.
About all Blue Cross-insured patients volition lose in-network coverage after this modify, including those who have insurance through Blue Cross providers in other states or on the federal level. Simply members of the State and School Employees' Health Plan, which Blue Cross manages, will remain in network.
Since 2018, UMMC has maintained that the insurance giant should pay the infirmary system larger reimbursements for care its hospitals provide, bringing UMMC's compensation more in line with other academic medical centers in nearby states.
Dr. LouAnn Woodward, UMMC vice chancellor for health affairs and dean of the School of Medicine, released a statement Monday challenging Blueish Cantankerous' rejection of the hospital'south asking for rate hikes.
"Blue Cross wants to compare the states to other Mississippi hospitals, but there are no hospitals in the country that are like u.s.a.. Every day we treat patients across Mississippi, many with nowhere else to turn, considering they need the specialty physicians institute only here at UMMC. Nosotros should exist compared to other bookish medical centers and safety net hospitals just like us," Woodward wrote.
In a response to queries from the Mississippi Gratis Press, Blueish Cross' Corporate Communications Manager Cayla Mangrum denied that UMMC could compare itself to other academic medical centers, and provided a statement contradicting UMMC.
"UMMC's press release is full of inaccuracies and misleading statements," Mangrum wrote in part. "Blueish Cantankerous & Blue Shield of Mississippi has been trying to piece of work with UMMC since early 2021 to renew their network hospitals, but UMMC's demands have made it very difficult to finalize an agreement."
In a 2nd argument, Mangrum went further. "There is no justification to pay UMMC more, for example, for an X-ray or bypass surgery, than it would whatever other Network Provider offering the aforementioned service," she wrote.
Remaining Patients In Three Tiers
Dr. Alan Jones, UMMC associate vice chancellor for clinical affairs and professor of emergency medicine, spoke with the Mississippi Free Press on March 29 to explain the consequences for Mississippians with Bluish Cross insurance.
Critically, Jones confirmed that the infirmary would go along to accept in-network payments for emergency patients routed to UMMC with Blue Cross insurance, due to requirements of the Emergency Medical Treatment and Agile Labor Deed, or EMTALA.
"Emergency patients—patients that suffer from conditions where they take no choice in their positions—all of those patients would go along to accept in-network coverage," Jones said. "The example being a meaning patient who goes into labor and is brought here and delivers the baby, who and then goes to the neonatal intensive-intendance unit of measurement. … We would keep to take in-network payments for them, because they are emergencies, non elective treatment."
But UMMC provides important medical services not available elsewhere in the state. For non-emergency situations, necessary treatment may become prohibitively expensive at the only infirmary in Mississippi capable of offer the proper level of care.
"For example," Jones continued, "if you demand a os-marrow transplant, we accept the but bone marrow transplant in the state. Well, those patients wouldn't exist able to access that program. So information technology would, they would have to call Blueish Cross to find out where Blue Cross wants them to go to get that treatment.
Representatives from UMMC and Blue Cross confirmed that, when UMMC goes out of network, Blue Cross-insured patients will be broken down into iii tiers. Blue Cantankerous will go along to fully cover emergency patients described above, but new patients would need to either pay out-of-network costs or detect another hospital in the network for their care, even if that would mean traveling to other states.
Bluish Cantankerous-insured patients currently receiving ongoing care at UMMC prior to the stop of the contract period on Apr ane, and who need UMMC to keep providing care, have a 90-day transition menstruation lasting until June 30. In that transition period, patients volition continue to be billed at in-network rates, subsequently which they will motion off-network every bit well.
UMMC Significantly Underpaid?
The impasse between UMMC and Blue Cross boils downwards to the value of the hospital circuitous to Blueish Cross' overall network. UMMC is seeking recognition of the unique part the hospital plays in Mississippi'due south health-care ecosystem. To Bluish Cantankerous, the infirmary is non significantly different from any other providers in the state.
"We obviously have the opinion that we are different because we accept a lot of unique services," Jones said. "To have those services results in a higher cost structure."
"(We're an) academic medical middle, and just like the other bookish medical centers in our region, (we) need a dissimilar reimbursement rate than other hospitals," he continued. "What they've said to u.s. is 'nosotros have an acceptable network without UMMC in it.' … By virtue of non negotiating with u.s.a., that signals that they don't believe they need usa in their network."
Ultimately, Jones says, UMMC is just asking to be paid close to what other bookish medical centers in the region offering. "In our region, an academic medical center is (typically) paid above 200% of Medicare," he explained.
This metric compares payments for service from Medicare to individual insurance, which is typically higher. "We are not even request to go to 200%. … We're asking for a 30% rate increase across all of our contracts. That won't even go the states two thirds of the fashion to where other academic medical centers are. … It is a significant enquire, only it's because we have been significantly underpaid for and so long now."
Mangrum did not dispute Jones' numbers, only denied that UMMC is underpaid. "Blueish Cross & Bluish Shield of Mississippi has offered UMMC increases in payment for unique services UMMC provides, such equally trauma, transplants and certain pediatric services," she wrote. "However, services bachelor at other Network Providers are paid consistently based upon the Mississippi market rate."
Mangrum's argument disputed the comparative value of UMMC. "As to UMMC's claim to exist paid more as an academic medical center, UMMC is comparing themselves to institutions they are not," she wrote. "For example, UMMC's publicly reported quality scores are lower than other nearby academic medical centers where our Members ofttimes seek services. Information technology is important to remember UMMC is funded through the Land of Mississippi, not past Blue Cantankerous Blue Shield Members."
To this statement, UMMC's Executive Director of Communications and Marketing Marc Rolph provided a list of Leapfrog scores for UMMC and another academic medical centers in the regions. UMMC's C rating placed it on par or higher than some large academic hospitals in New Orleans, La., Lexington, Ky., Mobile and Birmingham, Ala., Miami, Fla. and Piffling Rock, Ark. Some academic hospitals in the same states, nonetheless, have received A and B rankings.
'The Dominant Insurer'
Mangrum repeatedly challenged the assertion that UMMC had been underpaid in her argument, explaining that the electric current reimbursement rates had included a rate increase. "UMMC has not been underpaid," she began. "Any payment fabricated to UMMC was based on a mutually agreed upon and executed Network Agreement, with the most contempo agreement beingness in 2018. … UMMC had every opportunity to proceed its negotiation and not hold to anything."
Jones countered that the 2018 negotiations had brought frontward decades-quondam language and that UMMC had clearly requested college reimbursement rates at the time. "6 years ago we had contract language written when Dr. Woodward was in medical school. … We got all that contract language straightened out to be more modernistic and fair," he said.
"Nosotros told them back in 2018 that we'd be coming dorsum for negotiation, and information technology would be all right the next time, because nosotros did not feel that nosotros were adequately reimbursed the mode an bookish medical center should be."
Jones said Blue Cross' market dominance allowed it to command reimbursement—a tendency UMMC is now attempting to fight. "The real issue hither has been that (Blue Cross) have managed—considering they're the ascendant insurer in the marketplace—to go along hospital and doc reimbursement very, very low," he said.
Mangrum'due south statement closed with a quote from Blue Cross Blue Shield of Mississippi Chief Medical Officer Dr. Tom Fenter. "The health of our Members is of import. Ensuring they have admission to cost-effective, quality healthcare is our commitment and priority," Fenter wrote. "UMMC'southward media campaign and tactics will not distract us from that delivery."
Source: https://www.mississippifreepress.org/22412/ummc-dispute-with-blue-cross-blue-shield-may-force-insured-out-of-network-april-1
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