Mississippi Today was told by Chaney that the Department of Insurance in the state will address concerns about patients’ access to services at the University of Mississippi Medical Center’s Organ Transplant Unit and Children’s Hospital. These are services that are not available elsewhere in the state. Chaney stated that he couldn’t give details about how his office would address these concerns because of state confidentiality laws. According to officials from both organizations, communication between the hospital and Blue Cross/Blue Shield of Mississippi has been sporadic since April 1, when UMMC was officially out of network with the insurer. Tens of thousands Mississippians, some seriously ill and in need of advanced specialty services only at UMMC, are caught in the middle. “While UMMC & BCBSMS seem to have a further distance today than they did in 2018, I firmly believe the parties can find common ground that acknowledges and respects the unique role of UMMC in Mississippi’s academic medicine center, while also acknowledging and respecting BCBSMS’ vital role in maintaining affordable insurance for its enrollees.” Chaney’s letter to Dr. LouAnn Woodward (vice chancellor for Health Affairs and dean of UMMC’s School of Medicine) and Carol Ann Pigott, chief executives of BCBSMS), states that she is not UMMC. Marc Rolph, UMMC’s executive director of communications, and marketing, stated in a statement that they are open to mediation between the state’s largest insurer and the state’s sole academic medical center. This is in the best interest of Mississippi’s current and future patients. BCBSMS stated that it would not comment on the matter without directly responding to Chaney’s letter. Both Chaney and BCBSMS were given a deadline of April 27, in which to respond to his recommendation. Regardless of whether or not the parties agree to mediation the Department of Insurance will address concerns that UMMC’s out of network with BCBSMS violates the state’s network adequacy rules by denying patients access to medical services that aren’t available elsewhere in the state. Chaney stated this in an interview with Mississippi Today. Chaney stated that mediation is possible, but also the need to address network inadequacies at Blair Batson Children’s Hospital as well as the transplant unit. BCBSMS insists 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 BCBSMS, arguing it would allow BCBSMS continue to pay at unsustainable rates. Although the two sides have had similar disputes in the past, this is the first time that UMMC has been removed form 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’s hospital have been given inconvenient and expensive options to continue their child’s treatment. UMMC is the state’s only organ donor center. It also has the only children’s hospital and Level I trauma center. In 2018, the parties used the arbitration process Chaney recommended in the letter. It involves the appointment of an impartial mediator to preside over any new contract negotiations. UMMC requested the same increase in its reimbursement rates for 2018 as it is now. However, through a mediator, the parties reached a settlement that did not raise rates. Blue Cross instead agreed to delete language from the contract that made it evergreen. This means that the insurance company cannot change the terms of the contract at any time. According to Chaney, Mississippi Today will set a deadline for the parties to resolve their differences if they agree to mediation. The deadline is likely to be June 1, between 30 and 60 days before the expiration of the 90-day “continuity-of-care” period. During which certain BCBSMS patients may still receive treatment at UMMC, their insurance will still be accepted. Chaney cannot mediate or assist in settling disputes between insurance companies and providers of health care. However, Chaney stated that he would recommend a mediator to both parties if they agreed to the proposal. The disagreement between UMMC/BCBSMS stems out of disagreement over reimbursement rates. Blue Cross’ quality-care plan measures hospital performance and determines whether patients receive adequate care. UMMC has asked Blue Cross to increase its professional, inpatient and outpatient reimbursement rates by as much as 50%. Blue Cross’s overall reimbursement would rise by 30% during the first year. According to Milliman’s 2021 whitepaper, Mississippi has the lowest reimbursement rate for inpatient services from commercial insurance companies. While UMMC claims that BCBSMS pays them at a rate that is lower than the market for academic medical centers in the area, BCBSMS claims that they would have to increase their premiums if they agreed to the increases. BCBSMS & UMMC – Request… by William Stribling
BCBSMS stated that it would not comment on the matter without responding directly to Chaney’s request. Both Chaney and BCBSMS were given a deadline of April 27, in which to respond to his recommendation. Regardless of whether or not the parties agree to mediation the Department of Insurance will address concerns that UMMC’s out of network with BCBSMS violates the state’s network adequacy rules by denying patients access to medical services that aren’t available elsewhere in the state. Chaney stated this in an interview with Mississippi Today. Chaney stated that mediation is possible, but also that network adequacy concerns the Blair Batson Children’s Hospital as well as the transplant unit will be addressed. BCBSMS insists 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 BCBSMS, arguing it would allow BCBSMS continue to pay at unsustainable rates. Although the two sides have had similar disputes in the past, this is the first time that UMMC has been removed form 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’s hospital have been given inconvenient and expensive options to continue their child’s treatment. UMMC is the state’s only organ donor center. It also has the only children’s hospital and Level I trauma center. In 2018, the parties used the arbitration process Chaney recommended in the letter. It involves the appointment of an impartial mediator to preside over any new contract negotiations. UMMC requested the same increase in its reimbursement rates for 2018 as it is now. However, through a mediator, the parties reached a settlement that did not raise rates. Blue Cross instead agreed to delete language from the contract that made it evergreen. This means that the insurance company cannot change the terms of the contract at any time. According to Chaney, Mississippi Today will set a deadline for the parties to resolve their differences if they agree to mediation. The deadline is likely to be June 1, between 30 and 60 days before the expiration of the 90-day “continuity-of-care” period. During which certain BCBSMS patients may still receive treatment at UMMC, their insurance will still be accepted. Chaney cannot mediate or assist in settling disputes between insurance companies and providers of health care. However, Chaney stated that he would recommend a mediator to both parties if they agreed to the proposal. The disagreement between UMMC/BCBSMS stems out of disagreement over reimbursement rates. Blue Cross’ quality-care plan measures hospital performance and determines whether patients receive adequate care. UMMC has asked Blue Cross to increase its professional, inpatient and outpatient reimbursement rates by as much as 50%. Blue Cross’s overall reimbursement would rise by 30% during the first year. According to Milliman’s 2021 whitepaper, Mississippi has the lowest reimbursement rate for inpatient services from commercial insurance companies. While UMMC claims that BCBSMS pays them at a rate that is lower than the market for academic medical centers in the area, BCBSMS claims that they would have to increase their premiums if they agreed to the increases. BCBSMS & UMMC – Request… by William Stribling We are grateful for any amount that helps us continue producing high-quality journalism in Mississippi. Mississippi Today Nonprofit Mississippi News Mississippi Insurance commissioner Mike Chaney wrote a Thursday letter asking the state’s largest hospital to use the same mediation process as was used in 2018 to resolve their contract dispute. Mississippi Today was told by Chaney that the Department of Insurance in the state will address concerns about patients’ access to the University of Mississippi Medical Center’s organ transplant unit and children’s hospital. These services are not available elsewhere in the state. Chaney stated that he couldn’t give details about how his office would address these concerns because of state confidentiality laws. According to officials from both organizations, communication between the hospital and Blue Cross/Blue Shield of Mississippi has been sporadic since April 1, when UMMC was officially out of network with the insurer. Tens of thousands Mississippians, some seriously ill, and others who require advanced specialty treatment only at UMMC, are trapped in the middle of this dispute. “UMMC and BCBSMS appear to be further apart than they were in 2018, but I firmly believe that both parties can find common ground that acknowledges and respects the unique role of UMMC in Mississippi’s academic medicine center, while also acknowledging and respecting BCBSMS vital role in maintaining affordable insurance for its enrollees,” Chaney’s letter to Dr. LouAnn Woodward (vice chancellor for Health Affairs and dean of UMMC’s School of Medicine) and Carol Ann Pigottt, chief executive of BCBSMS), states that Marc Rolph, UMMC’s executive director of communications, and marketing, stated in a statement that they are open to mediation between the state’s largest insurer and the state’s sole academic medical center. This is in the best interest of Mississippi’s current and future patients. BCBSMS stated that it would not comment on the matter without directly responding to Chaney’s letter. Both Chaney and BCBSMS were given a deadline of April 27, in which to respond to his recommendation. Regardless of whether or not the parties agree to mediation the Department of Insurance will address concerns that UMMC’s out of network with BCBSMS violates the state’s network adequacy rules by denying patients access to medical services that aren’t available elsewhere in the state. Chaney stated this in an interview with Mississippi Today. Chaney stated that mediation is possible, but also the need to address network inadequacy regarding Blair Batson Children’s Hospital’s transplant unit. BCBSMS insists 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 BCBSMS, arguing it would allow BCBSMS continue to pay at unsustainable rates. Although the two sides have had similar disputes in the past, this is the first time that UMMC has been removed form 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’s hospital have been given inconvenient and expensive options to continue their child’s treatment. UMMC is the only state-funded organ transplant center. It also has the only children’s hospital and Level I trauma center. In 2018, the parties used the arbitration process Chaney recommended in the letter. It involves the appointment of an impartial mediator to preside over any new contract negotiations. UMMC requested the same increase in its reimbursement rates for 2018 as it is now. However, through a mediator, the parties reached a settlement that did not raise rates. Blue Cross instead agreed to delete language from the contract that made it evergreen. This means that the insurance company cannot change the terms of the contract at any time. According to Chaney, Mississippi Today will set a deadline for the parties to resolve their differences if they agree to mediation. The deadline is likely to be June 1, between 30 and 60 days before the expiration of the 90-day “continuity-of-care” period. During which certain BCBSMS patients may still receive treatment at UMMC, their insurance will still be accepted. Chaney cannot mediate or assist in settling disputes between insurance companies and providers of health care. However, Chaney stated that he would recommend a mediator to both parties if they agreed to the proposal. The disagreement between UMMC/BCBSMS stems out of disagreements over reimbursement rates and Blue Cross’ quality care plan. This measures hospital performance and ensures that patients receive adequate services. UMMC has asked Blue Cross to increase its professional, inpatient and outpatient reimbursement rates by as much as 50%. Blue Cross’s overall reimbursement would rise by 30% during the first year. According to Milliman’s 2021 whitepaper, Mississippi has the lowest reimbursement rate for inpatient services from commercial insurance companies. While UMMC claims that BCBSMS pays them at a rate that is lower than the market for academic medical centers in the area, BCBSMS says that they would have to increase their premiums if they agreed to the increases. BCBSMS & UMMC – Request… by William Stribling