Blue Cross will cover UMMC care if contract lapses

May 18--Blue Cross and Blue Shield of Mississippi has pledged to pay in-network rates even if the insurer and University of Mississippi Medical Center cannot resolve their dispute by June 30.

"We will continue to provide network-level benefits for care received from UMMC providers and facilities. This applies to adults as well as to children who need care at Batson Children's Hospital," said Meredith Bailess, Blue Cross director of corporate communications, in a statement.

UMMC officials said Blue Cross has yet to communicate with them directly, and the hospital system needs to better understand what the insurer's position is going forward.

"We can't take what they're saying at face value," said Marc Rolph, UMMC director of public affairs.

On May 1, UMMC notified Blue Cross that without resolution of contract issues they would no longer be a part of the insurer's network after June 30. The current contract dates back to 1990 and includes language that allows Blue Cross to make unilateral changes without input or notification to the University system, said Dr. Charles O'Mara, associate vice chancellor for clinical affairs. UMMC has offered Blue Cross a contract it considers fair and commercially reasonable. They are still waiting for a response.

"We are cautiously optimistic," O'Mara said.

UMMC officials had said they were still analyzing how they would handle Blue Cross billing if the contract expires.

Mississippi Insurance Commissioner Mike Chaney is not permitted to mediate provider contract disputes, but earlier this month he had urged Blue Cross and UMMC to work to find common ground ahead of the deadline.

"It is my expectation that should the contract actually terminate, (Blue Cross) will continue to pay network benefits and UMMC will refrain from balance billing patients until the parties resolve their differences," Chaney said in a statement.

Local impact

The dispute between University of Mississippi Medical Center and Blue Cross and Blue Shield of Mississippi is centered in Jackson, but potentially has repercussions in Northeast Mississippi.

Children's Of Mississippi specialty clinic in Tupelo offers pediatric cardiology, endocrinology, dermatology, neurology, psychiatry and urology as well as telehealth access to other specialties and is part of the UMMC system. That clinic would be affected if Blue Cross goes out of network.

University officials said its partnerships with North Mississippi Medical Center are not affected by the dispute. The two systems operate the Children's Clinics in Tupelo and Saltillo with NMMC employing the physicians and nurse practitioners and UMMC employing the clinic staff. UMMC pediatric hospitalists take care of sick children in the NMMC pediatric unit.

Patient impact

Not every Blue Cross customer is affected by the dispute; it depends on how the health insurance is structured. Those who purchase individual health insurance policies from Blue Cross or whose employers purchase policies for them are affected by the dispute.

State employees, for whom Blue Cross serves as the third party administrator, are not affected by the dispute because their network is written into their health insurance plan. For other large employers with self-funded insurance plans, the exposure depends on how the plan is written.

Even with Blue Cross pledging to pay network-level benefits, members affected by the dispute will have to file their own claims if there isn't a new contract by June 30, O'Mara said. Blue Cross will send them a check to cover its portion of bill, and patients will be responsible for getting that money and their share of the bill to UMMC.

Simmering dispute

The origin of the dispute between UMMC and Blue Cross goes back years, O'Mara said. Four years ago, UMMC negotiated changes in the rate structure with Blue Cross.

"We found later that the changes were negated by manipulation of the contract in other areas," O'Mara said.

Blue Cross leaders say UMMC has been unresponsive and unwilling to move with changes in the health care landscape and the needs of patients.

"While our contract has been in place with UMMC for a number of years, the payment program has continually evolved, as it has for all our network hospitals, to meet our customers' needs for quality, outcomes-based care with a focus on managing cost for all," Bailess said. "UMMC wants to be treated differently from other network hospitals in this regard and has continued to leave reimbursement opportunities on the table in their resistance to partner with Blue Cross & Blue Shield of Mississippi."

As the state's only academic medical center, UMMC is different from other hospitals in the state, O'Mara said. It is the only hospital in the state with the highest designation for trauma centers and neonatal intensive care units. It offers the only organ transplant center and the only children's hospital. In addition to caring for patients, it trains health care professionals and supports research.

"It's a hugely important resource for the state," O'Mara said. "It requires considerable investment."

NMMC conflict

In a lawsuit filed last August, NMMC-Tupelo also has taken issues with the provider network contract and unilateral changes to contract without input or notice. At the time it was filed, NMMC leaders said the changes Blue Cross had made were costing the hospital $1 million a month. The civil lawsuit is still pending in Lee County Circuit Court. So far, no deadline to resolve the dispute has been made public.

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