Jackson Jambalaya

Blue Cross is the poster child for malevolent insurance companies. I don't know much about the merits of HMA's claims in their lawsuit, but I do know that Blue Cross has zero.zero credibility when they speak.

Ok, HMA sued BCBS because they have been underpaid by their contract?

What does HMA retail charge have to do with that?

If BCBS had posted what they charge in network, it would look like ST.D and Baptist.

Charles Pace used to work for the commissioneers office. but has always been on the BCBSMS payroll.

hard to pick sides on this one, its like lex luther versus the joker. too bad they cant both lose

back in the late 80's they had a scheme in which BCBS would deny health coverage and if the policy holder protested enough, they would refer the claim to a committee of "the Mississippi Medical Association", which, reality, was a group of doctors hired by BCBS to hear cherry picked excerpts of medical records to ensure the "committee" agreed with BCBS adjustors nearly everly time. The real Medical Association found out its name was being used and demanded they stop; they didn't. Its no wonder that doctors and hospitals have no love for BCBS.

I'm rooting for HMA. Not a BCBS fan. Doubtful ins commish will do anything. Legislature needs to step in come January and level this playing field. Quite frankly, it was so much better when you just went to the doc if something was wrong and insurance wasn't involved. The person behind the desk is NOT the person I need medical advice from. that's why I go to a doctor.

"In just a few months, the whole world is going to be turned upside-down..." Well, BCBS, maybe you should have stopped licking your lips over Obamacare.

I know that they are paying him back from something 20 years ago, but it's time for BCBS to take Pace off the payroll. He is toxic.

The overriding issue is the law suite. BCBSMS cannot afford (not literally)to lose the case. They are in the wrong, everybody knows it, but if they lose, every other hospital will want theirs. They underpay routinely but the other hospitals are too scared to challenge them.

So, if BCBS gets really pissed and pulls entirely out of Mississippi, like some auto underwriters have done, what then? Then some goober politician like the insurance commish gets to establish some dumbass cousin to 'winpool'. Be careful what you axe/wish fer.

No love in these prior comments for BCBS but their plans are the most popular among employees year after year. If HMA's leadership was correct in filing suit, what does it say that its shareholders fired the entire board of directors shortly after? Who does that?

Yes, It chaps my ass when I drive by the Blue Cross campus everyday on lakeland. I see my premiums go up every year , just like the water fountain in their lake. Other than united health, I can't find anyone allowed to compete with blue cross. If I don't like Baptist or St D or ...I can just change Hospitals or Doctors in the Metro. Not Insurance. Blue Cross has a monopoly period.

3:15 please read up on the issue. BCBSMS is a Miss company. That's like saying the McDonald's in Miss are gong to get mad and leave. They have had a monopoly since they were allowed to operate as a non-profit until the mid 90's when they went for-profit, but had already garnered so much of the market because of the competitive advantage that gave them, they virtually control the healthcare industry in MS with no oversite. that's not healthy and everyone is starting to realize it.

Some of you are so uninformed,your premiums go up because hospital charges go up.HMA charges are by far the highest, more than twice as high as the other hospitals. And just wait to see what ObamaCare does to your premiums.

Hating on your insurance company is sort of like complaining about your spouse or boss... Everybody has a story they love to tell.
Seems to me if you cut through all the mud slinging, this hospital group out of Florida wants to make some more money. Do a little google research about HMA and you'll see they're being investigated and sued all over the place for over billing practices. You'll also see that their CEO got a 17% raise last year, up to almost $8 million... Does that sound like a company that needs Mississippians to pay more for medical services? More like modern carpetbaggers trying to play us for fools.

Doctors upset because their excessive charges are being called out and their mouthpiece consists of overpaid lobbyists and executives....how damn funny.

Care to guess what the local HMA executives get paid and i'm not talking about the real higher ups.

No one wants to talk about the faith based non profit hospitals in the area mandating referrals to specialists they control by their clinic networks or the promotion of doctors who essentially take care of nothing and refer everything. Wonder what the overall cost of unnecessary referral patterns is costing Blue Cross. In fact, Blue Cross has recently implemented a diabetes referral network that they control that will take patents away from their doctors and mandate that they see nurse practitioners in "centers of excellence." Big brother at its finest.

Healthcare is big business and HMA is in the business. Glad someone is trying to keep costs in check whomever is doing it.

There are NO good guys in this family argument, although BCBS has done the amazing thing of making HMA appear to be the poor step-child!

Does BCBS have a monopoly? Pretty much so. But HMA is not immune to criticism either, along with the other hospitals and health care providers.

BUT what I really want to ask is this - What business is it of the State? Why are our legislators holding hearings, other than so the various members can take a stand for their personal interests?

This is an argument between two private businesses - BCBS and HMA. The State has absolutely NO interest here. (Those that want to bring the Insurance Commissioner in to this argument don't know what the hell you are talking about, because the Commish has no regulation over health insurance rates.)

The 'hearing' was nothing but a show for the show horses to show (their a$$e$). The legislature has no business here - and everyone that is asking for them to intervene (on either side) should check your conservative, less government, credentials at the door.

11:27
I believe what you havn't heard is BCBSMS underpaid UMC by 30 million. Thats taxpayer money.

a little knowledge is a dangerous thing...The argument that HMA charges too much or is overpriced is nonsense in this issue. ALL reimbursements are agreed to in advance, except in rare occasions. a knee replacement is $X, a gall bladder is $Y. HMA and Blue Cross had a contract that they would be reimbursed a specific amount for specific procedures and BCBS reduced those reimbursements unilaterally in violation of the contract and HMA called them on it.
and by the way, HMA's board was fired because a group of stock holders revolted because they thought the current board agreed to sell to Community at a price they thought was too low. This skirmish in Mississippi is not quite to that level.

Sorry 9:02, but you're mistaken. The pricing varies based on instruments, surgical settings, assistant surgeons, etc. An HMA anesthesiologist botched my wife's epidural and they had to "stick" her again. They billed us for both, when we pointed out that it wasn't our fault that they first one didn't work they talked with the Dr who said my wife was too short so he wasn't at fault!

It is my understanding that TN, with a larger population has two BCBS top executives - MS has approximately six ??? If this is true, maybe someone could investigate why MS BCBS is paying top executives that other larger states function just fine without...

UMC underpaid? Was this criminal fraud?

The defenders of BCBS of MS will believe anything apparently.

And, for certain, they've never compared with other states.

Please explain defenders, why the co-pay in MS for Nexium is now $540up from $100 five years ago and in ALA with BCBS of ALA , it's $10 co-pay?

Explain also why our BCBS rates are so much higher for less coverage when our medical care isn't as expensive as in other states?

We've suffered and continue to suffer Insurance Commissioners and Commissions who aren't looking out for Mississippians but for BCBS of MS! God forbid they should actually do their jobs and we pay them too!

11:25 you are mistaken. HMA, St. D nor Baptist controls what the Dr.'s charge for their services unless that Dr is and employed Dr. This is strictly what the hospitals are reimbursed for procedures in their facilities. Having two injection on your wife instead of one is unusual but not germane to this discussion. The hospital would get reimbursed according that procedure code and the argument is that BCBS reduced the amount of reimbursement for procedure codes in violation of the contract. HMA can bill Blue Cross $6 million for a knee replacement and it would make no difference, they will get whatever amount they both agreed on in the contract.

"UMC underpaid? Was this criminal fraud? "

I think contract disputes go to civil court, not criminal.

Madison County had to fight the nuns of St D. for its new hospital NOW here comes BCBSMS with their crap. County employees have BCBSMS. The Entegrity Group administers the county medical insurance. The county started using the Entegrity Group while ELVIS Johnson was still a supervisor and now we see him at every board meeting making sure Entegrity Groups keeps the county's business therefore keeping the county with BCBSMS. If you look hard enough you'll find that Tim 'Elvis' Johnson has a vested interest in the Entergrity Group keeping the county's business.

When the county was Fox Everett and was administered in house everything was great! When the county went to BCBSMS and The Entegrity Group the rates went up up up and benefits started going down down down.

Now the county Human Resources Director has turned in her resignation effective this coming Friday over employee information being given to a life insurance provider and what would you like to bet that she resurfaces at The Entegrity group!!!!

HMA's rates are nationally recognized as the highest. This isn't an opinion, but a fact. More power to them if they can get the rates. This strategy helps them get better terms with insurers in a small way. But it personally impacts those without insurance - that breed set to die 1-1-14.

Certainly, HMA negotiates it fees ("in network, contracted rates") with certain payors which have patients the hospital wants. BCBSMS has the most patients in the state. HMA wants those patients coming to its hospitals. So, it negotiated rates with BSBSMS and entered a contract. When the contract was coming to expire, the parties couldn't come to terms on new rates. The existing contract then lapsed. Both sides knew it lapsed. BCBSMS was no longer obligated to pay HMA the old negotiated rates under the contract. Yet, HMA wanted to keep the rates they had been paid, so it decided to keep billing and demand that BCBSMS pay their rates as they always have. Because it didn't have a contract or any obligation to take HMA's demand, BCBSMS paid HMA "out-of-network" rates as they would with any non-contracted provider. HMA's upset because of the income lost from the difference between the in-network rates and out-of-network rates. Thus, the litigation. (Seems to me a daring bet by HMA).

I'd be surprised if an uninsured patient could walk in any of the 10 HMA facilities in MS and demand to pay only what they paid the last time.

I'm neither a fan of big Blue nor HMA. Let 'em fight it out. UMC and Blue decided their similar fight threw good money after bad and resolved their differences.

1:29
If this was intential it was stealing from the State of Ms.
If they would put a few of the BCBSMS brass in jail, it would send a message.

1:04, you're still not seeing the whole picture. It's not an oil change, where one charge gets you the whole package. As was said, they're are variables that impact how much a knee replacement costs.
Procedures codes have prices, that change over time, just like everything else in America
And frankly, a real world example of HMAs billing is spot on for this discussion. That's who they are... The goal is to maximize profit on every patient that walks in the door, or at least that what their employees say. But anyway, you know that already

I express no opinion in this debate as to which side is right, but anyone who thinks it clever to point out that HMA is for-profit, without conceding that BC is also for-profit, is selling something.

They're both corporations trying to make money. That's how America works. The question is whether their ability to mix it up in the marketplace needs to be regulated in order to keep patients (and physicians) from being hurt.

"Any willing provider" laws are something I hadn't heard of before this week, but they sound like a good idea. Any reason they're not?

If the charges on these procedures are so straightforward and flat rate, why won't the hospitals ever commit to a price in advance? Try calling around and getting an estimate on a hip replacement, for example..better yet, go down and ask for one in writing. They'll laugh you out of the place

6:14 A smart guy like you should recognize what a brilliant business opportunity this is for you.

Just set up a hospital where you can provide these fixed rates in advance and I guarantee you will have customers booked for months in advance, coming from all over the country.

It's amazing no one has figured out how to do this before you. Good luck, and let us know how it turns out. You have outsmarted those 100s of 1000s of guys who went got through college, med school, years of residency and fellowship training, then years of private practice, and still couldn't figure out what you have hit on.

You'll be bumping Bill Gates off the top of that Fortune 500 list in no time, I'm sure, with your "better (medical) mousetrap".

That's a good plan... Was that plan B, behind the Pro-Med software? Looks like that would've been the better capital investment but live and learn, right?

If the county HR Director has resigned, it's because of the recently exposed illegality of paying benefits to independent contractors. Anybody with six months background in HR knows what an independent contractor is, how to treat one, how to pay one and that they absolutely can NOT be given employer benefits (including insurance).

This has gone on for over a decade at the courthouse level and has been continued by several HR Directors. It's flat out illegal. The County will be writing a sizeable check to the IRS over this and it may even stall the 'park in nowheres-ville). This will cost us hundreds of thousands of dollars...more if penalties are levied, which they SHOULD be. This was not a mistake or ignorance. It was willfully breaking federal regulations.

On a related side note, Southern Farm Bureau is dropping BCBS effective Jan. 1

Just received a letter from Woman's hospital saying it dropped Blue Cross too.

Once upon a time,children, Doctors lived by the Hippocratic Oath and treated the sick. Sometimes, they were paid in livestock or labor or not at all as they healed the people and the people they tried to heal were grateful.
Then came insurance companies. At first, they had a good formula that was good for everyone. The people pay into a fund that was invested carefully so the money would be there when needed and the insurance company kept the unneeded money and a percentage of the profit they made on the money. It was like a forced savings plan so the money would be there and those who made the savings grow were rewarded.

Then, one day,men in black hats came to the doctors and said, you can make as much money as businessmen. You should be as rich as the richest businessman because you work hard and deserve it and you save lives. Saving lives should not be your reward, money should be. You should use a business model. They taught the doctors to each treat one illness or injury even though they knew how to treat many so that the patient would have to pay several doctors and not just one. They taught the doctors how to advertise and the importance of marketing and packaging their product so the doctors had beautiful offices. They should maximize the number of patients they see by adopting procedural assembly lines. They should never visit even the sickest patient at home as the travel time is time they should be billing other patients. Put the sickest in hospitals and even more profit can be made.
Insurance companies decided to spread the risk and gamble on high risk investments to increase profits.
There were no more professions. And respect for the professionals ended as the people saw there profit mattered more than curing the sick or ministering to the poor in spirit or making sure that justice prevailed in the land. Everything became a business.
The people became disgruntled but with good marketing and psychological manipulation, the people blamed each other. People even came to believe that it was often their fault they got sick. People were fat because they ate too much, not because their parents and grandparents were fat or their metabolism was slow or they had glandular problems. Even though many who indulged in the habits said to be bad never got sick, the people were made to judge one another.

Even when the plagues of autism and cancer took smiles and lives of the children grew wildly in numbers, even then, the people were too distracted arguing with one another to wonder why that would be. The focus was on better treatments rather than finding out why these plagues had come.

Those who tried to warn others were shouted down and money was given to make them appear foolish.

A land that was once good began to fail because they forgot that greed is a deadly sin and selfishness can one day cause others to turn on you in desperation.

8:14 Nice fairy tale.

"People were fat because they ate too much, not because their parents and grandparents were fat or their metabolism was slow or they had glandular problems. "

Unless they repealed the Second Law of Thermodynamics while I was plowing through your screed, I call BS. Neither matter nor energy can be created, they can just be converted from one to another. Therefore, if you consume more energy (calories) than you burn in a day, your body very efficiently stores the excess energy as fat. Likewise, if you burn more calories than you consume in a day, your body has to burn some of that stored fat for you to function. It is that simple. If grandma and grandpa were lazy slugs, or ate like pigs, the result is predictable. If you took them as your role models for life you sill get the same results.

RARELY, people have some medical problem that causes unusual weight gain. Also, some medications cause weight gain as a side effect.

There is no such thing as "slow metabolism". If that is your excuse it means you are eating too much for the physical activity you do each day.

A tremendous number of people are adept at self-deception and making excuses. If you are fat 1) eat less and 2) exercise more.

PS alcohol is a sugar (calories).

As far as your other pin-headed points - did you know over 28 MILLION medical articles were published last year? Do you think any doctor could keep up with ALL the advances made in ALL the specialties?