UMMC will stop accepting policies from BCBS of MS - MSNewsNow.com - Jackson, MS

UMMC will stop accepting policies from BCBS of MS

Source: UMMC Source: UMMC
JACKSON, MS (Mississippi News Now) -

The University of Mississippi Medical Center has announced it will stop accepting policies from Blue Cross Blue Shield of Mississippi, the state's largest private insurer, citing contract dissatisfaction.

The hospital, which has locations in Jackson, Grenada and Lexington, will stop accepting policies after June 30. Officials say the hospital can no longer abide a contract in which Blue Cross makes unilateral changes that cost the hospitals money.

WATCH: UMMC press conference on BCBSMS contract dispute PART 1

WATCH: UMMC press conference on BCBSMS contract dispute PART 2

UMMC officials say they find this "unacceptable" and they want a different contract.

“During the coming weeks, as we continue to negotiate with BCBSMS, absolutely nothing will change for our patients,” said Dr. Charles O’Mara, UMMC associate vice chancellor for clinical affairs.  “We encourage Blue Cross members to continue to visit their UMMC care providers just as they always have. Our goal is to maintain business as usual, so our patients do not experience any disruption in their care.”

Without a new agreement in place by June 30, UMMC will become out-of-network for BCBSMS customers, and those patients may face higher out-of-pocket costs. Normally, exceptions are made for patients who need emergency medical care or established patients who need continuation of care for an ongoing illness.

Failure to reach an agreement also would not impact members of the State and School Employees’ Health Insurance Plan and their covered dependents, because that plan is administered by but not offered by BCBSMS.

“We are committed to negotiating with Blue Cross in good faith,” O’Mara said.  “However, it’s important to understand that our current agreement with Blue Cross was developed 28 years ago, when UMMC and the health care industry were vastly different.  Most troubling, the base contract from 1990 allows Blue Cross to make any changes it wants to the terms of the agreement – including what it pays us for services we deliver to patients – without consulting UMMC.”

“Equitable contracts with our payor partners – like BCBSMS – allow us to keep the physicians, technology, facilities, staff and resources needed to provide the very best care possible to the people of Mississippi,” said Kevin Cook, CEO of the UMMC health system.

Unfortunately, Cook said, BCBSMS’ ability to manipulate reimbursement even after an agreement is signed means that any rate proposal UMMC might agree to can’t be counted on unless the base contract is revised. 

“We are committed to a strong, collaborative and fair partnership with Blue Cross and Blue Shield that supports our mission to improve the lives of Mississippians through exceptional patient care, training the next generation of health care providers, and engaging in innovative research,” Cook said.  “Through these continuing negotiations, we are optimistic we can reach a new agreement between our organizations.”

Blue Cross spokeswoman Meredith Bailess released this statement on behalf of the company:

“First and foremost, Blue Cross and Blue Shield members have nothing to worry about as we will continue to provide Network-level benefits for care received from UMMC providers and facilities. This applies to adults as well as to children who need care at Batson Children’s Hospital. We will work with our members to coordinate their care.  As always, in emergency situations, members should seek care at the nearest healthcare facility, and they can trust that their care will be covered.

We have been trying for years to work with UMMC, but we have found them unresponsive to our efforts to provide fair and equitable reimbursement aligned with the current healthcare landscape and care needs of our members. While our contract has been in place with UMMC for a number of years, the payment program has continually evolved, as it has for all our Network Hospitals, to meet our customers’ needs for quality, outcomes-based care with a focus on managing cost for all. UMMC wants to be treated differently from other Network Hospitals in this regard and has continued to leave reimbursement opportunities on the table in their resistance to partner with Blue Cross & Blue Shield of Mississippi.

As always, we keep our members and their care as our top priority, and they do not need to worry about the impact of UMMC’s action on their access to care or the level of benefits provided by Blue Cross & Blue Shield of Mississippi.”

Commissioner of Insurance Mike Chaney issued the following statement on the contract dispute between the insurance provider and the medical center:

My primary concern in this situation is that patients continue to receive access to quality healthcare without suffering financial penalties.  As Commissioner of Insurance, I am prohibited by regulation from acting to mediate or settle disputes between a health carrier and a medical provider arising under a provider contract.  I urge both BCBS and UMMC to work diligently to find common ground prior to the June 30th termination date.  It is my expectation that should the contract actually terminate, BCBS will continue to pay network benefits and UMMC will refrain from balance billing patients until the parties resolve their differences.

State employees and school employees covered by BlueCross will not be affected. 

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