UMMC goes out-of-network with Blue Cross Blue Shield

Mississippi's largest hospital went out of network with the state's largest insurer on Friday, meaning thousands of Mississippians will now face higher out-of-pocket costs for their health care or be forced to leave the state for certain specialty care.

This is the first time the state's only academic medical center has officially gone out of network and not had an active contract with Blue Cross Blue Shield of Mississippi, according to UMMC officials' knowledge.

Even though representatives for both sides have been meeting in person each week since January, the two entities were not able to agree to a new contract before the March 31 deadline.

UMMC is asking Blue Cross for substantial increases to inpatient, outpatient and professional reimbursement rates, some as large as 50%. UMMC maintains it's asking for below market rates for academic medical centers, while Blue Cross officials say that steep rate hikes would necessitate a substantial increase in customer premiums.

"We are disappointed that Blue Cross doesn't value the Medical Center enough to agree to a fair contract and keep us in its network," Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the UMMC School of Medicine, said in a press release. "We know that patients are disheartened and frustrated. We must – for the health and wellness of all Mississippians – stand firm in our resolve that Blue Cross should agree to pay us at fair market rates."

The two sides have also sparred over Blue Cross' quality care plan, which measures hospital performance and whether services provided to patients are adequate across 15 different categories. UMMC leadership has said that the complexity involved in the care the hospital provides means it should have an individualized quality care program, while Blue Cross maintains that UMMC should be held to the same standards as its other network providers.

"It is unfortunate we have not been able to reach an agreement," said Cayla Mangrum, corporate communications manager at BCBSMS, in a statement. "Unreasonable demands by UMMC for increased payments, along with their unwillingness to agree to Network Hospital quality requirements, are not in the best interest of our Members and Groups as we seek to provide access to quality, cost-effective health care. We will continue to work to reach an agreement with UMMC, but until then, our primary goal remains our Members' health."

There are certain services and facilities UMMC has that cannot be found anywhere else in the state. These include Mississippi's only Level 1 trauma center, Level IV neonatal intensive care unit and children's hospital, among other critical care services.

Insurance Commissioner Mike Chaney told Mississippi Today this week that he questions whether BCBS could meet the state's Managed Care Plan Network Adequacy Regulation without UMMC in its network. The regulation requires health insurance providers to "maintain a network that is sufficient in numbers and types of participating providers to assure that all devices to covered persons will be accessible without reasonable delay."

Cheney also said his office would get involved if the two parties didn't strike a deal by Friday.

This week, Mississippi Today spoke to parents whose children have been receiving specialty care at Children's of Mississippi. Few have received answers about what the future holds and some are scrambling to find an alternative provider for their children.

"The truth is we can't go anywhere else," said Lanier Craft, whose son has Pompe disease, a rare genetic condition that affects the muscles. "This is all there is for us. Batson has been there since I walked in the door in February eight years ago with my child. They have done everything for us, and to just completely lose that within a day because of an agreement over money is unimaginable."

There are three groups of Blue Cross Blue Shield customers that UMMC's out-of-network status won't apply to:

- Those enrolled in the Mississippi State and School Employees' Health Insurance Plan. Though that plan is administered through BCBS, only commercial insurance plans are affected.

- Patients who come into UMMC's emergency room or are transferred from another hospital.

- Patients for which UMMC has a continuity of care obligation. UMMC can't stop caring for, say, a pregnant woman in her last trimester of pregnancy or a cancer patient who is in round two of 12 rounds of chemotherapy. For these patients, this period of coverage will expire 90 days from April 1.

-- Article credit to Will Stribling of Mississippi Today