/Blue Cross members agonize over losing trusted doctors

Blue Cross members agonize over losing trusted doctors

Cooper’s pediatrician and Flowood’s gastroenterologist didn’t provide any answers. Van stated that although they tried to help Cooper, it felt like they didn’t take me seriously and that there was something else wrong. Her son was then referred to Dr. Michael Nowicki at University of Mississippi Medical Center, a pediatric gastroenterology specialist. He ordered a sweat test after she described Cooper’s symptoms to him. Nowicki was able diagnose Cooper with cystic Fibrosis. This is a condition that can cause severe damage to the lungs and digestive system, as well as other organs. This condition causes mucus, sweat, and other bodily fluids to thicken, which can lead to blockages in vital bodily functions. Cooper was diagnosed with a pancreatic disorder that hinders him from properly absorbing fats. “I have never felt so shocked in my entire life.” Van said that it was devastating for them. Van said, “It was devastating for us.” Cooper currently sees Dr. David Josey at UMMC as a pediatric pulmonologist. He also has a host of specialists who assist with managing different aspects of cystic fibrosis. Cooper is now uncertain about his care. Cooper is among tens of thousands of Mississippians who have suffered from UMMC’s decision to leave the network of his family’s insurance, Blue Cross & Blue Shield of Mississippi. The dispute between them stems out of disagreements over reimbursement rates, Blue Cross’ quality plan, which measures hospital performance as well as whether patients receive adequate services. Cooper will be able to continue receiving care at UMMC under his parents’ Blue Cross plan through July 1. They will then have to make tough decisions. A single-income household such as his can’t afford to pay thousands of dollars each month out-of-pocket. The only cystic fibrosis center that is accredited in Mississippi is UMMC. Cooper follows a daily home care regimen that allows him to lead a normal lifestyle. He uses a high-frequency, chest wall oscillation device (or a vest vibrating at high frequencies) to clear his lungs. A variety of medications have helped his digestive problems. His mom stated that the treatments he received from UMMC have helped him thrive and become an eight-year old who enjoys playing sports. Cooper’s treatment has “changed his life,” Van stated. Cooper was unable to be seen and told that there was something wrong. It wasn’t easy for Van to switch Cooper’s care from a Blue Cross hospital. UMMC is. There are two alternatives: the University of Alabama Medical Center, Tuscaloosa, and Tulane Medical Center, New Orleans. Although it is more expensive, Cooper could be purchased a separate insurance plan through UMMC. Van stated, “That’s where I want him.” Van stated, “They saved him his life and have given back his quality life… we’re just praying that it works out.” Officials from Blue Cross and UMMC have not communicated since April 1, when UMMC went out of network. On Thursday, Mike Chaney, Mississippi Insurance Commissioner, wrote a letter asking the parties to use the same mediation process as was used in 2018 to resolve their contract dispute. UMMC has asked Blue Cross to provide substantial increases in professional, outpatient, and inpatient reimbursement rates. Some of these could be as high as 50%. UMMC insists that it is asking for lower-than-market rates for academic hospitals. Officials from Blue Cross claim that rate hikes would require a significant increase in customer premiums, despite an investigation by Mississippi Today that found that the insurer has a large reserve of money. Nicolette Brokaw, a Vicksburg resident, has been attending UMMC since she was a child. As an adult, she has been going to the same doctor for 10 years. She treats her for Alpha-1 antitrypsin deficiencies (AAT deficiency), which significantly increases a person’s risk of developing liver or lung disease. Brokaw decided that it was not worth worrying about six months ago, when she received a letter by Blue Cross alerting her to the contract dispute at UMMC. They had already resolved similar disputes in the past. She could not control the outcome. With UMMC no longer in network, she is now anxious about the difficult and emotionally draining task of finding a doctor she can trust. Brokaw stated that she would have to tell her entire life story over again. “They’re going look at me as if I have six heads. And I don’t wish to go through that.” Another worry is the search for a new doctor to treat Liam, her three-year old son with autism. She has been worried about Liam’s absence seizures. These are very common in autistic kids and can cause brief, abrupt lapses of consciousness. Brokaw stated that Liam stares into space occasionally, but her intuition says it is not normal. Brokaw could take Liam to Dr. Lamar Davis at UMMC if she had the chance. Liam has already seen Dr. Lamar Davis. Brokaw stated that she wishes she could have Liam back to him to solve this problem. However, it is not possible for her to do so because she cannot afford to pay out-of-pocket for a neurologist. “… “I wish money wasn’t an object. But it is.” Brokaw currently tries to get Liam coverage under the Disabled Child Living At Home special eligibility category for Medicaid in Mississippi. Although Liam was already diagnosed with autism, Social Security disability rules require that Liam undergo a behavioral evaluation using an autism rating scale in order to be eligible for coverage. Brokaw stated that the first diagnosis was “black and white”, but that it wasn’t good enough. Brokaw said, “It is ridiculous.” Brokaw may take Liam to Ochsner Medical Center New Orleans. However, this comes with its own financial difficulties. Even if she can get an appointment, the additional gas and hotel expenses will put strain on her family which is solely dependent on her husband’s income. Brokaw’s biggest concern is knowing that those who make business decisions that put her family’s health at risk and other people are protected from the consequences. Brokaw stated, “I cannot imagine what these other people living at the hospital are going through.” It’s not the CEO and board members who are being hit. They won’t have to worry about filling up their cars with gas. They can return to their $500,000 homes. They can visit the doctor whenever they wish.