Jackson Jambalaya

Blue Cross-HMA.  HMA-Blue Cross.  The scrum between the two companies has dominated the news for quite some time in Mississippi.  The entire battle started with a lawsuit HMA filed against Blue Cross.  The media reported HMA filing the lawsuit but really has not analyzed the lawsuit, much less posted a copy of it for you to read.  JJ will attempt to do so in this post.
HMA* filed suit against Blue Cross/Blue Shield of Mississippi on June 18, 2013 in Hinds County Circuit Court and demanded a jury trial. HMA asked for actual and punitive damages against Blue Cross for breach of contract and alleged Blue Cross's actions cost HMA more than $13 million in 2012 and 2013.  HMA also asked the court to prohibit Blue Cross from modifying the contract between the two companies without its consent. 

Unfortunately for the readers, HMA did not attach a copy of the contracts to the lawsuit, citing confidentiality clauses.  However, HMA does quote an alleged passage that is common to each contract:

This agreement may be amended at any time during the term of the agreement by mutual written consent of duly authorized representatives of the parties.  Any changes to Attachment A policies and Procedures or Attachment B payment program shall be made known to the hospital in writing at least thirty days before the proposed changes are to become effective.  Said changes must be mutually agreed upon prior to implementation.

HMA will pummel Blue Cross with this "mutually agreed" clause over and over in the complaint.  HMA then quotes another passage alleged to be in each contract:

In the event of conflict between the provisions of this attachment B payment program and the participating hospital agreement or Attachment A policy procedures manual or attachment C APC polices and procedures manual, the provisions of this Attachment B shall prevail.

HMA states Attachment B provides the rates that Blue Cross must pay HMA.  HMA alleges that for years the two companies would negotiate rate increases as needed when costs and market conditions changed.  HMA claimed it could not reach an agreement with Blue Cross in late 2011 and the two have ever since remained at a stalemate.

Now the lawsuit gets technical so read slowly. ;-)  Remember Attachment A? The policies and procedures part of the contracts? HMA accuses Blue Cross of trying to "insert" into Attachment A some "provisions" that would change the reimbursements stated in Attachment B.  The alleged result is that while one section states the rates, the other section quietly changes them.  Needless to say that if true, HMA would not be happy about this action.   HMA argued it did not agree to any of these changes and that Blue Cross inserted the changes into Attachment A without its consent.  Pages 8-11 of the complaint provide more technical details in support of these allegations.

Its definitely a political-charged case as proved by recent events.  HMA alleges the ten hospitals represent ten percent of the population in Mississippi.  Blue Cross responded to the lawsuit by terminating network status for all ten hospitals although four rural ones were reinstated.  Blue Cross cited a clause in the contracts that allowed it to terminate network status if it gave HMA a sixty-day notice.  It is hard to analyze this case as the contracts were not attached to the complaint. The case was transferred to Rankin County Circuit Court.   Blue Cross may be correct under the contract as to how it terminated the hospitals.  However, HMA may win in court and still win a judgement against the insurer. 

*HMA Hospitals:  CMMC (Jackson), Biloxi Regional Medical Center, Crossgates River Oaks Hospital, Gilmore Regional Medical Center (Amory), Madison River Oaks Medical Center, Natchez Community Hospital, Northwest Mississippi Regional Medical Center (Clarksdale), River Oaks Hospital (Flowood), Tri-Lakes Medical Center,, Woman's Hospital at River Oaks (Flowood)