/Man in need of transplant can’t get answers from Blue Cross, UMMC

Man in need of transplant can’t get answers from Blue Cross, UMMC

He is both helpless and stumped by the circumstances in which he finds himself. After being diagnosed in 2020 with end-stage liver disease, Dungan had to have dual hip replacement surgery and a variety of procedures on his stomach. He also needed tests from a number of specialists in order for him to be eligible for a transplant at the University of Mississippi Medical Center. This is the only state organ transplant program. He is currently not eligible for a transplant due to the ongoing contract dispute between Blue Cross & Blue Shield of Mississippi (his insurer) and UMMC. He is unable to get clear answers from Blue Cross or UMMC regarding the cost of life-saving surgery or how he should proceed. He said, “I’m afraid I’m going freaking to die,” but it was hard to know. He lists the number of people and agencies that he has reached out to, including the governor, U.S. Congress members, and the insurance commissioner. Staffers for Senator Cindy Hyde Smith and Mike Chaney, the Insurance Commissioner, made several calls to Dungan but nothing has happened. “I’m getting no help.” Dungan spoke to Mississippi Today previously on condition of anonymity, out of fear of retribution by UMMC and Blue Cross. After weeks of trying to get clear answers from either side about his health care, Dungan decided to speak out. Dungan tried to get a quote from UMMC on the cost of a liver transplant and a Blue Cross estimate of its coverage over the last month. Blue Cross members can ask their insurer to send them an in-network benefit amount, which they can use to pay UMMC. However, members are responsible for any difference between what Blue Cross pays or what UMMC charges. His luck has been a mixed bag. Blue Cross’s case manager directed him to be on the Methodist Transplant Institute transplant list in Memphis due to UMMC being out of network. He asked the insurance company if the entire cost of his Memphis transplant, including rehabilitation, would be covered. He said that he couldn’t get an answer. Mississippi Today’s Mike Chaney, Mississippi Insurance Commissioner, said that “what they’re doing is wrong.” He simply wanted to know what the estimated cost of a transplant would be. Both the parties owe him an explanation.” Marc Rolph (executive director of communications, marketing and communications at UMMC) said that Mississippi Today transplant candidates “should have been able to obtain a good faith estimate of what a transplant would cost and follow-up care costs.” However, it’s not clear why Dungan still hasn’t received this estimate as of Friday. Dungan has exhausted all avenues of help he can find to get assistance. Dungan considered buying health insurance from the public market, but the language is confusing and he isn’t confident about the coverage. He’s also already met his Blue Cross $7,000 annual deductible. He would have to start over with a new plan if he did not. He asked his doctor to refer him to the Memphis transplant centre, but he is concerned that he might not even be accepted. “What if they take me to Memphis or Birmingham for an evaluation, and I am not that bad?” Dungan said. His Model for End-Stage Liver Disease score (MELD), which is a measure of severity of the disease, has fluctuated between high and low. “I want to stay with UMMC because I have seen this rollercoaster in mine MELD score… they understand it.” Dungan, who has cultivated relationships over the years with his UMMC providers and pays almost $1,200 a monthly for his Blue Cross insurance, now faces a difficult decision. Even though the parties have reached an agreement to mediate, it is not binding. This means that either side could withdraw at any time. Dungan could wait for Blue Cross or UMMC to resolve the dispute. However, there is no guarantee they will and there is no deadline. He could also proceed with a complicated evaluation at an outside-of-state transplant centre that he doesn’t know much about, and which may not accept him as a candidate. Dungan prefers to stay at UMMC where he knows his doctors and has seen a variety of specialists. Dungan also said he doesn’t want or need to move to Memphis. He does not want to have to pay for the gas, lodging, and food costs that he would be paying to travel back and forth. He said that Blue Cross doesn’t seem to be able to comprehend the financial and physical burden of getting on the Memphis transplant list. They trivialized it. That’s what I thought. He said that it was a big deal for him to drive three hours. He also noted that he has to often pull over on long trips to rest due to fatigue from liver failure. He was then dismissed when he asked the company if they would help offset the cost. Dungan said, “They kinda guffawed at this.” Cayla Mangrum is the manager of corporate communications at Blue Cross. She said that she can’t answer any questions about Dungan because confidentiality rules prevent her from doing so. She did point to federal law, which requires hospitals to continue to provide care to certain patients and accept in-network payment for a specified time. Mangrum stated in an email that “this would apply to transplant patients.” UMMC said that Mississippi Today does not consider transplant candidates under the law as the recipient of a transplant requires a lifetime prescription of expensive immunosuppressant medications and care for many more days than 90. Rolph, spokesperson for UMMC, stated that you don’t want a patient to have a transplant tomorrow. If their insurance (coverage), is gone by July 1, they will be facing high costs and no recourse. This is not right. It is in the best interests of patients to be listed with a facility that they have confirmed… that they will get coverage for the entire of their care.” Blue Cross refused to offer this and UMMC requested a 30% increase in reimbursement rates. Patients, especially those who receive care that is not available elsewhere in the state, such as Dungan, have suffered collateral damage from the dispute. UMMC is the state’s only organ donor center. It also has the only children’s hospital and Level I trauma center. Patients and policyholders cannot understand the details of the contract because they are kept secret. Although specific Blue Cross reimbursement rates for outpatient and inpatient services are not public, studies have shown that commercial reimbursement in Mississippi is among the lowest in the nation. Blue Cross, which holds 56% of Mississippi’s market, is the largest private insurer. United, which is second in size, claims just 17%. According to UMMC Blue Cross has not offered any increases in reimbursement rates for at least 2014, according to UMMC. Marc Rolph, the hospital’s executive director of communication and marketing, stated that after a decrease in reimbursement rates between 2014 and 2017, the hospital was able to negotiate a 1% increase for 2018. Blue Cross officials aren’t in agreement with UMMC’s claims, but they won’t reveal any details. “The information provided to us by UMMC does not reflect factual facts. Mangrum stated that they cannot comment further on the matter as the terms and conditions for the mediation agreement must be kept secret. “In addition, confidentiality is required for the underlying agreement. “We are disappointed that UMMC has not just discussed the mediation, but also misrepresented the facts in doing it.” Dungan continues to try to take care his health and advocate for himself. Dungan recently purchased a property at a lake, where he enjoys fishing. He has changed his outlook on fishing and his diagnosis. He said, “It’s about getting to go and not catching fish.”