UMMC management sent this email to its employees recently:
TO: All UMMC Employees
FROM: Dr. James E. Keeton, Vice Chancellor for Health Affairs
SUBJECT: Contract Negotiations with Blue Cross Blue Shield of Mississippi
For the past few months, the University of Mississippi Medical Center has been meeting with representatives of Blue Cross and Blue Shield of Mississippi (BCBSMS) to renegotiate the level of payment UMMC receives for providing health-care services to the insured beneficiaries of BCBSMS. We believe, based on substantial evidence, that UMMC is significantly underpaid by BCBSMS compared to academic medical centers nationally, regionally and in states that border Mississippi. Because these discussions have made little progress to date, we felt we had no alternative but to notify BCBSMS that we intend to terminate our contract with them on June 28, 2013. (I added the emphasis)
We want to assure everyone that we remain committed to working with BCBSMS to achieve a fair and equitable agreement. However, if the issue is not resolved and the contract ends, BCBSMS beneficiaries may continue to rely on UMMC for their care but may incur higher out-of-pocket costs for using a provider that is “out of network.”
Please note, this does not affect employee participants and their dependents in the State and School Employees Health Insurance Plan, which is administered by BCBSMS. It involves employee groups and individuals who are direct customers of BCBSMS in the commercial insurance market. But because some of your loved ones may be on a BCBSMS commercial plan, we wanted you to be aware of this situation. Students who participate in the institution’s BCBSMS managed student health insurance plan would also be affected should an agreement not be reached by June 28.
Academic medical centers like ours play a unique role in our society. They offer advanced services not available at other facilities. UMMC provides the state’s only Level 1 Trauma Center, only Children’s Hospital, only level IV neonatal intensive care unit and its only organ transplant services, among many others. Along with the Mississippi Department of Health, we are the lead medical agency designated by the state to respond during disasters. And we are relied upon to search for new treatments and cures for conditions that disproportionately afflict the citizens of our state.
The availability of these unique services benefits all Mississippians. But for UMMC to offer these and other advanced services, it’s important that our insurance partners recognize the value that our academic medical center provides and pay us fairly – on par with our peers in neighboring states. To do otherwise means that other funding sources must make up the difference.
We apologize in advance for any inconvenience or hardship this may create for our BCBSMS insured patients. We pledge to keep them apprised of our progress and to provide more detailed direction if that becomes necessary. We want everyone to understand that we consider this to be a very serious matter or we would not have undertaken this course of action.
Please know that whatever happens, we are here to take care of you and your family. We take our responsibility to the people of Mississippi very seriously and can assure you that we will make every effort to reach an agreement with BCBSMS.
Thank you.
Saturday, May 25, 2013
UMMC leaving Blue Cross "network"?
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47 comments:
Dr. Keeton is a full-grown man!
I am retired from UMC and about 10 years ago United Healthcare tried the same thing and UMC became an out of network hospital with them. After a few years of patients complaining to United Healthcare they worked out a contract with UMC. We will see how long it BCBS to settle with them.
IMO UMC was the loser in the imbroglio with United. More patients left and didn't return than those who opted to pay out-of-network (70% or less) and/or returned once an agreement was reached. The standoff lasted too long (years) and damaged the customer base who went elsewhere and developed (a) relationship(s) with new (a) provider(s).
If BCBS viewed the UMC-UHC skirmish as a loss for the insurance industry they would have settled already. The truce with United wasn't a victory for UMC despite 3:44's attempt to allude to some rousing beatdown of an insurance company.
Bluster and hardball doesn't work in a market where patients have numerous other quality choices for service.
To 5:31 I never said anything about a beatdown of an insurance company. All I said was that it was eventually settled. Like it or not there are some medical services that can only be received at UMC i.e. they have the only pediatric orthopedist in the state.
UHC is also one of the most difficult insurance companies for the providers. They usually hate them.
The number of unique medical services only provided by the University Med Center shrinks with each passing day.
I worked for the C-L when we changed from BC to UH. Man what a mess, most everyone's doc were not in the network only one hospital. It got a little better but not much.
The Gannett Executives all kept BC by the way.
BCBS dropped provider reimbursement rates by 25% last month. I wonder if that reduction has anything to do with UMCs current situation.
Did they? I am not sure about the rate drop. Where did you hear that?
Our company's plan is with Cigna and is also out-of-network with UMMC. UMMC refuses to negotiate. So all the pretty UMMC advertising is offensive to our employees since we can't use UMMC. UMMC would prefer to serve undocumented aliens and Medicaid recipients over those of us with health insurance. But UMMC sure is able to spend my state income tax dollars!
History.. BCBSMS did this with St. Dominic and NMs Medical center.. BCBSMS caved on all three about a year after the fight began, this will be no different
As a UMC employee, I see both sides. I am glad they don't just accept lowball payments from insurers, and it is true they need private payers to cover their losses on indigent care. The state appropriation only covers about 9% of the budget and the money is all earmarked for education and special programs. Shutting out this many private patients will help create more healthcare alternatives in the community, especially since UMC does a great job of training its competition.
BTW After 10 years without a contract with United, UMC reached an agreement with them only after they were awarded the SCHIP contract.
@1200: yes, I'm sure about the rate drop.
"It is true they need private payers to cover their losses on indigent care"
Especially when the state government refuses to expand Medicaid to offset the millions of dollars UMC is about to lose in DSH funding.
"yes, I'm sure about the rate drop. May 26, 2013 at 9:35"
Does the rat drop apply to certain CPT codes and not others? Did not see anything about it on the BCBSMS site. Please explain. I know about the pathology changes but what else are you referring to
Especially when the state government refuses to expand Medicaid to offset the millions of dollars UMC is about to lose in DSH funding.
UMC is the government Dope.
UMC is the government
UMC is dependent on federal DSH funding to offset uncompensated care, just like any other hospital. They get a budget from the state, but that budget isn't being increased by the state to make up for the revenue that UMC's going to be losing from the feds. Money's gotta come from somewhere, and apparently UMC has decided it needs to come from BCBSMS.
Is this a negotiation right here on JJ? ;-)
They get a budget from the state, but that budget isn't being increased by the state to make up for the revenue that UMC's going to be losing from the feds.
Your premise is yet to be determined. You're only repeating the fear mongering of the hospital lobby and Democrats.
BCBS played this game with Baptist East in Memphis earlier this year. Baptist refused to accept BCBS for a few months. BCBS eventually caved...the same way they will cave to UMMC.
At one infortunate time in my HR career we switched to United Healthcare. I was amazed the number of medical providers who said outright and upfront that they do not deal with United. I still see those notices in waiting rooms and on pre-op forms given to patients by a number of facilities.
Of note; How many of you are aware that the ambulance service contracted to Hinds and Madison Counties (AMR) is also NOT in BCBS's network and hasn't been for years. If you need ambulance service, how many of you expect to shop for an ambulance or ask your plan for a list of in-network meat wagons? How absolutely insane is that?
Blue Cross sucks. We have never regretted moving to United Health (who also offers a Health Savings Account option).
Is this just BCBSMS or all of BCBS? We have BCBSAL, but the only pediatric endocrinologists in the area are at UMMC.
3:15. Yes, I knew about ambulance service not being a BCBS provider. I was in a car wreck in 1996 in Rankin County, and the ambulance service I had to use then was not a BCBS provider either. Also, in 2010 another family member had to be transported by ambulance from River Oaks Hosp to St. Dom, and BCBS was not a provider then either. My BCBS policy paid some of the cost, but very little both times.
That's an outrageous reality, 3:15 and 9:42. A call to BCBS blames the non-network ambulance debacle on AMR. Hell, it's not the fault of AMR that BCBS will only reimburse 60% of the cost of hauling a patient to the hospital. BCBS is the biggest shakedown artist this side of Jesse Jackson.
4:52; you're actually full of crap if you expect anybody to believe you're celebrating a move to United Healthcare. No other plan experiences anywhere near their number of "Ah, we don't deal with them" comments from service proviers. The health savings account option you laud is a pauper's pittance compared to the red flags one encounters when pulling their card out of a wallet.
Blue Cross of Mississippi in the past 10 years has transformed from one of the best insurances for both the recipient and the provider to one of the biggest pains in the ass.
FWIW, UMMC is now blocking access to JJ through their wifi at UMMC.
United Healthcare is a great example of a legalized criminal enterprise. Horrible insurance. Avoid them like the plague.
i wonder how the BCBS reimbursements stack up to medicaid? im sure that BCBS reimburses more than medicaid but you dont see UMC dropping medicaid patients? many times provoders have to make up the losses from medicaid/medicare from the private guys. will be interesting to see if/when BCBS caves.
"FWIW, UMMC is now blocking access to JJ through their wifi at UMMC."
So which constituency do they want to obstruct? The employees or the revenue-producing physicians?
Shades of Dan Jones!
I believe it's not legal for a hospital to refuse to accept medicaid patients, isn't it 3:07?
the provider decides whether to file to m'caid-- they are considered payor of last resort...
Those who go to UMMC with medicaid have no other insurance. Either the provider files it or eats it. Actually, in that case, they are the payor of ONLY resort.
wrong 6:37.
some are hurt on the job and covered by workers comp; others have had accidents and covered by auto ins. or premises liability. those are all primary to 'caid.
UMMC is not blocking JJ on its wifi. All of blogger/blogspot is extra slow recently. I'm on here now.
??
UMMC changed its internet filters before this particular thread started, but this site is almost always blocked with a warning about "Proxy Avoidance", whatever that is. If you try to open several comments you will get that or another warning. You can ask the help desk, and explain to them why you're reading this thread at work :-) [I'm writing from outside UMMC now]
My opinion of BCBSMS is they are one of the worst, if not the worst insurance carriers in the country. The BCBS Association needs to audit their business practices immediately. My opinion on the CEO, Carol is she thinks she is a medical doctor and a pharmacist. Everyone that has BCBSMS insurance will be spending a lot more money out of pocket than they used to, to pay employee and executive bonuses, to continually remodel interior of buildings on Lakeland Dr, for no reason other to spend money. To bring foreigners with H1B visas into the building to work on projects (ICD-10) instead of allowing the local BCBS employees to work on them. The BCBS executive team monitors everything about their employees, including credit, watching message boards to ensure no one outside of BCBS knows how screwed up they are. I could go on and on, that is why I retired from this company, I could not go on any further watching the executive team destroy BCBS MS. Bring back Rick Hale and get rid of Carol and her cronies.
6:27, can UMC employees access and post to facebook from work? Just curious.
I totally agree with the comment from 9:40 last night. I just left the company not long ago due lito how they treat employees. They spend all of your hard earned money on changing the interior of the buildinng (major renevations) and building a 50 million data center. The only part that I did not agree with was the part about bonuses for the regular employees. They only give bonuses to executive staff and management. It was also rumored that all of the VP's got a title change so they could get raises and no one else in the company can.
Also about all of the ICD-10 personal is bad for local Mississipians that need jobs. Blue Cross would rather spend your money on them and also on people working in India.
I can access Facebook but I haven't tried posting.
I can read Dilbert and Doonesbury online but if I try to read Mallard Fillmore it is blocked with a not stating it is a "games/puzzles" page or violation. Very weird.
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Note to 10:36 - Hate to break it to you, but those people in India generally have a much better grasp of syntax, grammar, vocabulary, etc, than you seem to have (e.g., "personal" is not the same as "personnel").
I'm not 10:36, but that was clearly a typo. You should read some of the emails that some of "them" send out (IT management) and you will see how tight this "grasp" of the English language really is. I myself do not understand hiring those on the visas into our workforce period, let alone changing them from remote work to bringing them into the building.
And the regular employees do indeed get bonuses. No one speaks of it.. it just appears on your statement. Depends on what department you work in.
What do you expect from an insurance company that told employees: If any executive is behind you...you hold the door for them an let them go before you.
Just wondering if there is anything new on UMC leaving the BCBS network? Anyone heard? Thanks.
Now we definitely need a new update. WJTV reported last night River Oaks, Womans, Rankin, Madison, and I believe CMMC also are being dropped by BCBS. The companies that owned this hospitals sued BCBS over reduced reimbursements, and now BCBS is dropping them come Aug 1, 2013.
http://www.wjtv.com/story/22854875/miss-insurer-could-cut-ties-to-2-hospital-systems
Article on companies suing BCBS over reimbursements:
http://www.modernhealthcare.com/article/20130620/INFO/306209983
I just got a memo from work to not use these hospitals. That are now out of network. Hmmm
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