Geoff Pender opined on whether Blue Cross/Blue Shield is indeed a monopoly in Mississippi:
BlueCross BlueShield is flexing its muscles, and its nearly monopolistic hold on Mississippi’s insurance market could allow it to upend state health care, shutter already scarce hospitals, force patients to travel long distances, pay more or receive substandard care.
It appears time for state government, which helped BCBS achieve its catbird seat atop the health insurance market here, to step in. Lawmakers are holding an initial hearing on the issue Monday. I suspect it will be a gut-check for Mississippi politicians, whether they’re willing to tackle the mighty BCBS, which, by the way, administers the state government health care plan.
BCBS and numerous hospitals have been at odds for years, with hospitals saying the insurer wasn’t paying them what it should for services and that it was using its huge market share (81 percent, according to the Kaiser Foundation) to strong arm them.
Health Management Associates, which runs 10 hospitals in Mississippi, sued BCBS in June, claiming it had been underpaid $16 million. In response, BCBS canceled HMA’s contracts starting Aug. 31. This means patients would have to pay large, out-of-pocket costs to use those hospitals. HMA is temporarily paying the difference for patients while the fight continues.....
But BCBS got where it is by having nonprofit, tax-exempt status from 1948 to 1995. Private companies couldn’t compete, and BCBS built up a market share and bankroll before it changed to for-profit status and state insurance deregulation that still makes it hard for others to compete. Mississippi has one of the least competitive insurance markets in the U.S
BCBS appears to be becoming the tail that wags the dog. No need for lawmakers or insurance commissioners to set policy. BCBS will tell everybody how it’s going to work.
It’s also gut check time for state Insurance Commissioner Mike Chaney, who has reportedly indicated he’s powerless to step in... Rest of the article
Interesting stuff and the rest of the column is worth reading.
16 comments:
I see the CL is posting op-eds on the front page. So sad.
I don't believe in insurance monopolies either.
The underlying corruption may be shocking to those outside the insurance industry, unbelievable even, but to those in the industry, this sort of intimidation happens regularly and in some segments of the industry it may even operate as a substitute for a marketing department.
You know, "it's just business."
I find it sad how a company like Blue Cross of MS can act like a bully on the playground...which has resulted in innocent nurses being laid off at Jackson hospitals, patient surgeries being postponed or moved to another hospital, surgeons schedules being interrupted, and some patients even receiving a lower quality of healthcare...nothing positive has come out of BCBS flexing their muscle
Quit whining 10:30. Can you back up your assertion that 'some patients have even received a lower quality of healthcare'? And whoever told you medical insurance had anything to do with healthcare.
I can back up patients receiving a lower standard of care because of BCBS. My daughter was born 7 weeks premature with severe respiratory problems. During RSV season (October - February) her pediatrician wanted her to have shots to prevent her getting RSV as it could be life threatening for her. The shots are given monthly because they only protect for around 30 days. Each shot costs $1500-$1800. BCBS approved 1 for her. We appealed as far as we could and got denied. She ended up getting RSV and being hospitalized. It was touch and go for a couple of days with her. The hospital bill ended up costing them more $ than the shots would have. They said she didn't meet the requirements for the shots because she was less than 8 weeks early and born in July not later. This was there fault.
11:54, you are such an idiot, I hope you have BCBS and need some type of specialized medical surgery that is only offered at River Oaks...then you will understand
September 16, 2013 at 9:43 AM, so you limited your newborn's care to only what the insurance would pay?
4:52, here is some news: not everyone has the $ to pay for medicine. Not even when it's for their child. I'm happy for you that your life hasn't made you aware of that previously.
I get it 6:40 PM, you see insurance as a free piggy bank.
6:55, that does not follow from what I wrote, just from your own fantasy of the 47 pct. insurance isn't free. One pays premiums. Or are you on Medicare?
You didn't get your newborn the necessary shots because the insurance said no. Your newborn was hospitalized because you didn't do the right thing despite what the insurance was willing to pay. You limited your newborn's care to only what the insurance would pay.
What hideous people enjoy this blog.
No worries, Baptist health systems is gonna take care of all the BCBS patients now, according to their billboards around town.
No I didn't limit her care to what they would pay. Could you afford $1500-$1800 a month for a shot? For each shot? I even tried to get the pharmaceutical company to help. But they wouldn't because I had insurance. Isn't that what insurance is for? We are by no means wealthy and paid my premiums and expected them to uphold their end of the contract. So glad that the 2 people who commented have deeper pockets than we do. I would have begged borrowed or stolen to get her those shots. But at a minimum cost of $9000 for all of them it was impossible. I hope you are never in the position that we were. Then maybe you will have your eyes opened.
Baptist can't do it. They can skim some cream, but they can't handle the OB let alone the NICU.
What is wrong with some of you? Many hardworking parents these days would not be able to pay those vaccination fees. You pay insurance premiums thinking that you will receive the healthcare you need, not to have that company tell you they won't cover a needed vaccination. Either way, BCBS spent more money treating the virus. They could have paid for the vaccinations up front and saved thousands of dollars. Our system is so screwed up. A hardworking mother/father has to choose what care to provide for their children due to financial constraints, yet millions sit at home everyday and never worry a moment about how to pay for their healthcare because our system takes care of them.
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