Insurance Commissioner speaks on NMHS-United Health dispute

Oct. 23--JACKSON -- The Mississippi Insurance Department is looking for progress in efforts to resolve a dispute between North Mississippi Health Services and United Health Care.

Both NMHS and United Healthcare have complied with a request from Insurance Commissioner Mike Chaney for detailed reports on how they are working to resolve charges that the insurer failed to pay the hospital system accurately and fairly.

"We should be in a position to address whether significant progress has been made in resolving the dispute by the middle of next week," Chaney said.

In April, North Mississippi Health Services noticed electronic reimbursements were coming across as paid, but at $0 for some United Healthcare subscribers. When the two companies failed to resolve the issue by the end of September, the Tupelo-based system publicly announced plans to terminate its provider agreement with the insurer for 2017.

Chaney and the state insurance department staff have spoken extensively with staff from both companies and requested reports showing significant progress by Oct. 21.

"I have significant concerns as to the impact the termination of the Facility Participation Agreement will have on consumers in North Mississippi," Chaney wrote to the leaders of the United Healthcare Gulf States region and North Mississippi Health Services.

If a resolution can't be reached, United Healthcare customers, including those with coverage through the insurer's commercial products, Medicare Advantage and Mississippi Medicaid CAN coordinated care network would be out of network as contracts expire in 2017. About 7 percent of NMHS patients are covered by United Healthcare.

Leaders at both NMHS and United Healthcare have said they want to see the issue resolved.

Terminating the provider agreement would affect North Mississippi Medical Center-Tupelo on Jan. 1. NMMC community hospitals in Pontotoc, Iuka, Eupora, West Point and Hamilton, Alabama would go out of network May 22. North Mississippi Medical Clinics would be affected on Aug. 14.

Next steps

If Chaney and his staff feel there has not been significant progress, they could take further action. The department would look at the documentation and other information from United Healthcare and NMHS to determine if claims had been paid properly. The commissioner could direct payment adjustments, depending on the findings.

"Fines and other penalties could also be imposed if warranted under the facts and law," Chaney said.

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