Blue Cross/Blue Shield announced yesterday it was unilaterally reinstating four HMA hospitals yesterday to "in-network" status. Blue Cross stated in a press release (posted below):
On Friday, October 18, 2013, Blue Cross & Blue Shield of Mississippi reaffirmed to the following HMA hospitals its offer to reinstate the hospitals as Network Providers:
- Gilmore Memorial Regional Medical Center in Amory
- Northwest Mississippi Regional Medical Center in Clarksdale
- Tri-Lakes Medical Center in Batesville
- Woman’s Hospital in Flowood
“Blue Cross clarified with each hospital that the reinstatement offer was based on their exact prior Agreement with no additional requirements; and that the offer was not contingent on HMA dismissing its baseless lawsuit. HMA has not responded,” said Meredith Virden, Manager Corporate Communications.
“Since HMA has not responded to our offer to reinstate these four hospitals as Network Providers, we will once again take the leadership role and recognize these hospitals as Network Providers beginning today and provide network-level benefits for our members.”
HMA sued Blue Cross and alleged Blue Cross cut reimbursements to HMA hospitals without HMA approval as required by contract. HMA operates ten hospitals in Mississippi. Blue Cross terminated the contract with HMA after the lawsuit was filed. Blue Cross's decision meant it would not pay the higher "in network" reimbursement rates to HMA hospital, thus making them more expensive to policyholders if they used HMA services. Governor Phil Bryant threatened to order Blue Cross to reinstate all ten hospitals last week but has yet to issue an executive order. Blue Cross filed suit in federal court Friday to stop him from doing so.
Insurance Commissioner Mike Chaney also told Blue Cross he ordered a review of the company and the insurance market in Mississippi. JJ obtained through a public records request a letter sent last week to Blue Cross from Commissioner Chaney. Mr. Chaney stated:
On October 10, 2013, the MID met with representatives from your office to discuss the status of the ongoing examination of BCBS. As part of this meeting, the MID placed the company on notice that additional follow up will be forthcoming from our examiners specifically in the area concerning network adequacy and compliance with Miss. Code Ann. Section 83-41-409. The review of network adequacy was included in the initial scope of our exam which began around Mayr 1 of this year and was concluded prior to the BCBS/HMA dispute. In light of these events, which include the departure of the ten HMA hospitals from your network, the MID believes that it is necessary to perform an in-depth subsequent review to determine compliance with applicable market conduct standards and statutory provisions. (p.4 in documents posted below)
Mr. Chaney said the review should be complete by December 1.
10 comments:
Your reporting is so much more thorough and complete Kingfish. And you include original source documents not found available on any other mainstream media outlet nor from the entertainment weekly operating out of Fondren.
Thanks.
Hey 'wants a Bromance with Rocky' at 8:18--a double negative occurs in your second sentence among other problems....
Isn't Blue Cross the administrator for the Teacher/State Employee health insurance program? And don't they get millions upon millions a year to "administer" it, even though it is a self-insured program?
Maybe it's time to let another insurance carrier "administer" the State's program -- maybe an insurance company with a smaller Mississippi market-share. No sense feeding the monopoly, especially a monopoly that hurts Mississippians.
bcBS' slogan is "It's good to be Blue."
If you are HMA or one of bcBS' customers, not so much.
10/14/13 BCBS News Release: “Blue Cross & Blue Shield of Mississippi has advised HMA numerous times that it was willing to re-contract with some HMA hospitals if HMA would permanently dismiss its baseless lawsuit.”
10/22/13 post with BC press release: “Blue Cross clarified with each hospital that the reinstatement offer was based on their exact prior Agreement with no additional requirements; and that the offer was not contingent on HMA dismissing its baseless lawsuit.
…if HMA would permanently dismiss lawsuit…..
OR
…was not contingent on dismissing lawsuit…
???
Cheney cites 83-41-409
83-41-409. Conditions for certification or recertification
In order to be certified and recertified under this article, a managed care plan shall:
(a) Provide enrollees or other applicants with written information on the terms and conditions of coverage in easily understandable language including, but not limited to, information on the following: (i) Coverage provisions, benefits, limitations, exclusions and restrictions on the use of any providers of care; (ii) Summary of utilization review and quality assurance policies; and (iii) Enrollee financial responsibility for copayments, deductibles and payments for out-of-plan services or supplies;
(b) Demonstrate that its provider network has providers of sufficient number throughout the service area to assure reasonable access to care with minimum inconvenience by plan enrollees;
(c) File a summary of the plan credentialing criteria and process and policies with the State Department of Insurance to be available upon request;
(d) Provide a participating provider with a copy of his/her individual profile if economic or practice profiles, or both, are used in the credentialing process upon request;
(e) When any provider application for participation is denied or contract is terminated, the reasons for denial or termination shall be reviewed by the managed care plan upon the request of the provider; and
(f) Establish procedures to ensure that all applicable state and federal laws designed to protect the confidentiality of medical records are followed.
Attention please for one minute. HMA will be sold to CHS in the first quarter of 2014. There won't be any HMA hospitals anywhere after that. The ONLY reason that HMA is spreading so much money around now to politicians and ad agencies,is that the SALE PRICE is impacted by an agreement with BLue Cross. Do you all REALLY care how much Money HMA sells for to CHS???? I didn't think so
BCBS has already lost one large company due to this mess with over a thousand employees in the state. I am wondering how many other companies are changing?
Posting talk I have listen to about this whole deal. True or not I don't know
Mormon Church has become a majority holder in HMA.
The Community Hospital chain in Nashville is trying to buy HMA (sale pushed by new stockholders). This hospital group has a stellar relationship with BC in all their hospitals. Community has hospitals in over 20 states.
What if anything this has to do with current situation I don't know, but as they say follow the $$$$$$$
I listen to HMA's spill on TV, "some of the best Hospitals in Mississippi". I can't speak for all of them, but I know about Central and River Oaks.
My father used to go to Central and he got terrible care. The nurses wouldn't clean up after an accident such as a unine spill from a bag they droped. They just took off and left it.
River Oaks used to be great but they have gone down in the last few years. I fell and thought I had broke ribs so I went to their Emergency room. They didn't even have a doctor on duty.
.The last time I was in the Hospital there; they failed to give me one of my regular heart meds. What happened was the doctor had ordered it, but my nurse didn't see the order.
I prefer St Dom or Bapt.
Baptist and St doms have been doing back room negotiatoins with BCBS for a while, adjusting charges down for preferential treatment and BCBS referrals and keeping payments out of doctors pockets but getting year end bonuses for their foundations. It would be funny to see what would happen if they lost their non profit status.
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