/UMMC goes out of network with BCBS, impacting thousands

UMMC goes out of network with BCBS, impacting thousands

According to UMMC officials, this is the first time that the state’s sole academic medical center has been officially out of network. It also does not have an active contract with Blue Cross Blue Shield. Although representatives from both sides met in person every week since January and were able to reach an agreement before the deadline of March 31, the entities could not agree on a new contract. UMMC has asked Blue Cross to increase its professional, inpatient and outpatient reimbursement rates by as much as 50%. UMMC insists that it is asking for lower rates than the market for academic medical centers. However, Blue Cross officials claim that significant rate increases would require a significant increase in customer premiums. “We are disappointed that Blue Cross does not value the Medical Center enough for them to negotiate a fair contract and keep them in their network,” LouAnn Woodward, vice-chancellor for health affairs, and dean of UMMC School of Medicine stated in a press release. We know that patients are frustrated and disheartened. “We must, for the health of all Mississippians, stand firm in our resolve to have Blue Cross pay us fair market rates. The sides also argued over Blue Cross’ quality-care plan. This measures hospital performance and determines whether patients receive adequate services across 15 categories. Blue Cross claims that UMMC should have an individualized quality program due to the hospital’s complex care. UMMC leadership maintains that UMMC should adhere to the same standards as other network providers. Cayla Mangrum (corporate communications manager at BCBSMS), stated that it was regrettable that they could not reach an agreement. “Unreasonable demands from UMMC for higher payments, together with their unwillingness of agreeing to Network Hospital quality standards, are not in our best interests as we seek to offer access to quality, affordable health care. While we will work with UMMC to reach an agreement, our primary goal is our Members’ Health.” There are some services and facilities that UMMC does not offer elsewhere in the state. These include Mississippi’s only Level 1 Trauma Center, Level IV Neonatal ICU Unit, and Children’s Hospital, as well as other critical care services. This week, Mike Chaney, Mississippi’s Insurance Commissioner, said that he was unsure whether BCBS can meet the state’s Managed Care Plan Network Adequacy Regulation if it does not have UMMC. According to the regulation, health insurance providers must “maintain an adequate network in terms of numbers and types to ensure that all devices to covered individuals will be available without unreasonable delay.” Cheney said that his office would intervene if they don’t reach a deal before Friday. Mississippi Today interviewed parents whose children were receiving specialist care at Children’s of Mississippi this week. Many have not received any answers and are now scrambling for alternative providers. “The truth is that we can’t move anywhere else,” Lanier Craft, whose son suffers from Pompe disease, a rare genetic condition that affects muscles, stated. “This is all that is left for us. Batson has been there for me since the day I entered the building in February 2008 with my child. They have done everything we asked. To just lose that in a matter of a money agreement is absurd.” There are three categories of Blue Cross Blue Shield customers to which UMMC’s out of-network status will not apply: