UMMC Could Be Remvoed From Blue Cross Insurance Network By April 1
CBS - 12 WJTV (Jackson, MS)
JACKSON, Miss. (WJTV) – Leaders with the University of Mississippi Medical Center (UMMC) announced Blue Cross & Blue Shield of Mississippi is expected to force UMMC hospitals, clinics, physicians and other providers out of its commercial insurance network by April 1, 2022.
UMMC said it is being paid between 70% and 80% less than other hospitals in nearby states.
"Blue cross underpays us compared to the way insurers pay other academic medical centers. And we have indicated to Blue Cross that we cannot continue to accept these low payments," said Dr. Alan Jones.
Hospital officials said Blue Cross & Blue Shield stopped negotiations with them after their last counter-proposal in early March. In a statement to 12 News, Blue Cross Blue Shield said the following:
"Blue Cross & Blue Shield of Mississippi is committed to ensuring safe, high-quality care is provided to our Members. To that end, we have worked with hospitals and physicians to measure hospital performance in key clinical areas such as heart attack, pregnancy, patient safety and preventing readmissions," said Dr. Lee Greer, Corporate Medical Director. "To date, UMMC has been unwilling to participate in the quality program that has shown success in improving care for Members in the other Network hospitals in our state. Given UMMC's performance on publically reported clinical outcomes, it is important that the discussion focuses on not only reimbursement, but the quality of care that is being provided for common conditions treated by UMMC and all other hospitals across the state."
The insurance giant also argues that these rates were agreed upon back in 2018. But UMMC said there was another issue they wanted to negotiate before the rates.
"We had contract language that was written and had been carried on over the previous 30 years. It was 30 years old. And at that time, we also had a problem with our rates we were being paid. We decided as an institution at that time to get the contract language cleaned up and fixed and to not push the issue on rates," said Dr. Jones.
Patients currently in the hospital would continue to be treated, but new patients would not receive in-network benefits. And finding another hospital within the Blue Cross & Blue Shield network could mean having to go to another state for treatment.
"We offer services that a lot of other hospitals don't. We're the only trauma center in the state of Mississippi. We have the children's hospital in the state of Mississippi. We're the only transplant center in the state of Mississippi. And we have a lot of physicians that are the only specialists of their kind in the state of Mississippi," said Dr. Jones.
Blue Cross & Blue Shield said if UMMC does become non-network Friday, most of the services provided at UMMC can still be provided by other network hospitals.
If the contract expires, it will not affect state or school employee plans. Only commercial Blue Cross & Blue Shield plans would be impacted.