/Blue Cross, UMMC agree to mediation to settle dispute

Blue Cross, UMMC agree to mediation to settle dispute

After Mike Chaney, the Mississippi Insurance Commissioner, sent them a April 21 letter requesting that they agree to mediation, the decision was taken. An impartial mediator can be appointed to preside over any new contract negotiations. This is called arbitration. Chaney informed Mississippi Today that he will be making several recommendations to potential mediators by next Wednesday. Blue Cross and UMMC used the exact same mediation process to resolve their 2018 contract dispute. It took approximately ten days for them to reach a settlement, Chaney stated. Blue Cross reached an agreement with UMMC to end the clauses that made the contract permanent. This meant that the insurance company couldn’t change the terms of the contract at any point. UMMC claims that Blue Cross made annual changes in their reimbursement rates between 2014 and 2017. This decreased the total reimbursement UMMC received for Blue Cross patients. However, no changes have been made since then to their reimbursement rate. Once the parties have agreed on the mediator, they will set a deadline for settlement. Mississippi Today was told by Chaney that the deadline would be June 1, 30 days prior to the expiration of the 90-day “continuity-of-care” period. This is where certain Blue Cross patients will still be able to receive care at UMMC, and their insurance will still be accepted. Chaney cannot mediate or assist in settling disputes between insurance companies and providers of health care. This is according to state agency rules. Chaney’s involvement is due to concerns that UMMC’s inability to be part of Blue Cross’ network would violate state network adequacy regulations. This is because UMMC provides services that are not available elsewhere in the state such as its organ transplant unit or children’s hospital. BCBSMS claims that it still meets its network adequacy requirements even without UMMC. BCBSMS stated that it is possible to offer network-level benefits to customers in situations where network adequacy becomes a problem. It has already offered this by asking its members to sign a written directive of payment instructing the insurance company to pay the hospital. UMMC refused to accept these payments from BCBS because it would allow BCBSMS continue to pay at unsustainable rates. According to officials from both organizations, UMMC has not been in contact with Blue Cross since April 1, when UMMC went out of network. Tens of thousands Mississippians, some of whom are seriously ill or in need of advanced specialty treatments only available at UMMC, are caught in the middle. Although the parties have had previous contract disputes, this is the first time that UMMC has been removed form the BCBSMS network. Tens of thousands of Mississippians are now left with higher out-of pocket medical costs or to seek care elsewhere. Potential transplant recipients who spent years or months on the organ donation waitlists were placed on hold. Parents of children who need specialized care and can only be provided by UMMC’s children hospital have been given inconvenient and expensive options to continue their child’s treatment. UMMC has asked Blue Cross to increase their professional, inpatient, and outpatient reimbursement rates by up to 50%. Blue Cross’s overall reimbursement would rise by 30% during the first year. According to Milliman’s 2021 whitepaper, Mississippi has the lowest inpatient reimbursement rate among commercial insurance companies. UMMC claims that BCBSMS pays them at a rate that is lower than the market for academic medical centers in the area. However, BCBSMS claims that allowing the increase would require significant premium increases for customers – despite a Mississippi Today investigation revealing that the insurer has a large reserve of money.