Wednesday, May 2, 2018

UMMC terminates Blue Cross contract, Commish responds

UMMC and Insurance Commissioner Mike Chaney issued the following statements.

UMMC

The University of Mississippi Medical Center (UMMC) is in negotiations with Blue Cross & Blue Shield of Mississippi (BCBSMS) for an updated contract with the insurance provider, with the hope for a new agreement over the next two months.

UMMC notified BCBSMS management Monday that it will terminate the current agreement on June 30, 2018.

“During the coming weeks, as we continue to negotiate with BCBSMS, absolutely nothing will change for our patients,” said Dr. Charles O’Mara, UMMC associate vice chancellor for clinical affairs. “We encourage Blue Cross members to continue to visit their UMMC care providers just as they always have. Our goal is to maintain business as usual, so our patients do not experience any disruption in their care.”

Without a new agreement in place by June 30, UMMC will become out-of-network for BCBSMS customers, and those patients may face higher out-of-pocket costs. Normally, exceptions are made for patients who need emergency medical care or established patients who need continuation of care for an ongoing illness.

Failure to reach an agreement also would not impact members of the State and School Employees’ Health Insurance Plan and their covered dependents, because that plan is administered by but not offered by BCBSMS.

“We are committed to negotiating with Blue Cross in good faith,” O’Mara said. “However, it’s important to understand that our current agreement with Blue Cross was developed 28 years ago, when UMMC and the health care industry were vastly different. Most troubling, the base contract from 1990 allows Blue Cross to make any changes it wants to the terms of the agreement – including what it pays us for services we deliver to patients – without consulting UMMC.”

As the state’s only academic medical center, UMMC offers the only Level I trauma center and children’s hospital in the state, the only organ transplant service, and one of the most extensive telehealth networks in the nation.

“Equitable contracts with our payor partners – like BCBSMS – allow us to keep the physicians, technology, facilities, staff and resources needed to provide the very best care possible to the people of Mississippi,” said Kevin Cook, CEO of the UMMC health system.

Unfortunately, Cook said, BCBSMS’ ability to manipulate reimbursement even after an agreement is signed means that any rate proposal UMMC might agree to can’t be counted on unless the base contract is revised.

“We are committed to a strong, collaborative and fair partnership with Blue Cross and Blue Shield that supports our mission to improve the lives of Mississippians through exceptional patient care, training the next generation of health care providers, and engaging in innovative research,” Cook said. “Through these continuing negotiations, we are optimistic we can reach a new agreement between our organizations.”

Contrary to criticisms leveled by BCBSMS about UMMC’s costs and quality outcomes, data suggests that UMMC hospitals’ cost structure is among the lowest in the country, according to the Association of American Medical Colleges. Benchmarked against peer academic medical centers, the hospitals’ adjusted expense per patient day is well below the 25th percentile in recent national rankings.

“We’re one of the best bargains in the country,” said Cook.

Similarly, UMMC’s quality data have improved markedly over the last two years and continue on an upward trajectory in the most current ratings. Quality scores can lag by almost two years, so UMMC publishes its current quality data online.


Insurance Commissioner Mike Chaney

My primary concern in this situation is that patients continue to receive access to quality healthcare without suffering financial penalties.  As Commissioner of Insurance, I am prohibited by regulation from acting to mediate or settle disputes between a health carrier and a medical provider arising under a provider contract.  I urge both BCBS and UMMC to work diligently to find common ground prior to the June 30th termination date.  It is my expectation that should the contract actually terminate, BCBS will continue to pay network benefits and UMMC will refrain from balance billing patients until the parties resolve their differences.”
 

46 comments:

Anonymous said...

Ha! The University of Mississippi seems to be getting its comeuppance. Those who have the gold make the rules. It's way past time for some accountability, and BCBS certainly has the moral authority to make those health outcomes happen, and BCBS certainly doesn't need to be subsidizing an organization that gets a billion a year from the state to play with. It's high time Oxford started eating at the grown-up's table, instead of thinking they can lord over and exploit and profiteer off of poor Mississippians.

Anonymous said...

BCBS could stand its own comeuppance, with an incompetent staff in place to review and deny a ridiculous amount of medical claims. You have to fight for your own health after paying premiums for years. Deny, deny, deny! Their system needs to be completely overhauled.

Wow said...

Yea, 3:30 is in the lead for the idiot of the day. Literally ask anyone working healthcare in Mississippi about the worst payor in the State. Hands down it is BCBS across the board.

Anonymous said...

Hey 3:30 - Oxford has nothing to do with this. The "billion a year" is to run medical/nursing/PT/OT etc schools, not to treat patients.

OTOH, Didn't BC/BS try this same stunt a few years ago with Merit River Oaks in Flowood?


A pox on both their houses.

Anonymous said...

3:30 - strange that you say UMMC is getting is comeuppance - looks to me like its the other way. Or at least equal. Bitch as you want about UMMC (you ought to get your facts right first though - to think that UMMC gets a billion a year from the state is laughable considering the states $6 billion budget, the K-12 gets $2.5 billion, Medicaid gets $1 billion - aint another billion for UMMC considering all the other claims on the budget) but besides that little detail; BCBS payment rates are ridiculously low considering the premiums they receive from the insureds.

Hate UMMC's billing process because it does need modernizing and costumer friendly improvements. But damned if I am going to come to the defense of BCBS that has much worse costumer service and that you have to fight with EVERY time you make a claim.

Anonymous said...

The denial/appeals process is there to shape appropriate and positive health OUTCOMES. NOT just "provide services" and to turn a profit because you're the only game in town....THAT is what UMMC has been doing for decades and the gravy train is over....over-testing, over-medicating, over treatment, and over-billing are abusive. UMMC had better wake up.

Anonymous said...

THIS is why insurance companies need to be out of the equation of healthcare accessibility and why it's WAY past time to figure out a single-payor system like every other industrialized nation in the free world.

Anonymous said...

The word moral and Blue Cross do not fit together.

Anonymous said...

The US health system is a mess, but single-payor systems are collapsing faster than ours. Eliminating a management component will only bend the cost curve higher and at a faster rate.

Anonymous said...

The mission of BC/BS is the same as the mission of every health insurance company: Turn a profit. They do this by collecting premiums and denying claims. It's a pretty good model, once you get past those pesky ethics.

Anonymous said...

This is posturing on the part of UMMC and will likely turn into a Mexican stand-off for the next couple of months. Unfortunately for them, BCBS is in a better negotiation position, as the largest private insurer in the state. UMMC is counting on the threat of their going out-of-network with UMMC driving employers (and to a lesser extent, individuals) to move to another insurance carrier that is contracted with UMMC (United, Aetna, etc.). However, insurance typically only renews once a year, and BCBS is probably figuring that UMMC will fold before too many of their subscribers defect to anther insurer.

There will be much hand-waving from Chaney, and his office will step in to broker the peace, but my money is on BCBS giving up very little in the negotiation. And, frankly, UMMC may only be looking for a little, but for them, even a little bit helps their cause as BCBS likely makes up 25% or more of their revenue.

Anonymous said...

Who in the world signs a contract that allows the other party to change the terms anytime and in any way that they want?

Anonymous said...

These come up every few years. Nothing to see here. They will work it out by will or by force. Happened with HMA 4-5 years ago. Happened with NMMC 13-14 years ago.

Anonymous said...

If any of you want to know how some of your BCBS premiums are spent, please drive by the BlueCross BlueShield building in Flowood on Lakeland Drive and take Flynt Drive going south. Two blocks down is an astro-turf soccer field (no, I'm not kidding) with BCBS's logo in mid-field, along with a volleyball court and full basketball court. At least twice a week (weather permitting), many of the employees are out their playing either soccer, volleyball, or basketball during the day. Nice gig if you can get it.

If you don't believe me, please drive over and see for yourself. You cannot miss it.

Anonymous said...

4:57--not to mention the high salaries of people who are lucky enough to be employed there..

Anonymous said...

Right 4:57 PM! AND all of their employees should be forced to wear shitty grease stained clothes and drive cars at least 15 years old on bald tires.

Anonymous said...

Almost all of you have no idea what the future holds in healthcare. It is this: Patients are going to be held accountable for their lifestyle choices which research has conclusively proven leads to either PREVENTABLE health problems or a very high quality of functional health. Until you lose weight, stop smoking, put down the whiskey, start getting some daily physical activity - and that's just as a start.....you may not have your medical procedures covered. Believe it because it's coming and there's nothing anyone can do about it, nor should. It's the right (morally and fiscally) thing to do.

Anonymous said...

I am far from being a Bernie fan but I am about ready for Medicare for all.

Anonymous said...

Obamacare, such a sad episode in modern U.S.A. life....

anyway, obamacare has already created this lifestyle accountability in health insurance.

the problem is that health insurance has to pay for it one way or the other. on the front end with paying for trainers, gym memberships, treadmills at home etc or on the back in due to poor health.

Anonymous said...

"I am far from being a Bernie fan but I am about ready for Medicare for all."

Look it up - Medicare denies a much higher percentage of claims than BC/BS. Then where do you go?

Anonymous said...

i'm calling bullshit on BCBS and UMMC. My now 18 moth old son, was prodded probed and suffered for 7 months with UMMC, who finally diagnosed him with a rare birth defect. Next step, a potential life changing operation. BCBS paid wonderful on the bills from UMMC. I wanted a second opinion from a Dr. and hospital who specialized in this disorder and had a dedicated staff for this condition before this horrible operation. I took him to Nationwide Children's in Ohio who is in the BCBS network and was authorized before traveling. We are very blessed because my son was misdiagnosed and only suffered from a chronic condition that was easily treated and corrected with in 2 weeks. Well BCBS decided that most of the treatment that my son got to cure his condition could have been provided in state so now they are denying over 25k of his medical bills from Nationwide Hospital. Something really stinks, when BCBS had rather pay for a totally not needed reconstruction surgery, but not pay for the correct treatment because it was out of state. My eyes were opened to the quality of healthcare we are lacking in Mississippi compared to Ohio. Hopefully BCBS will come around and cover my child's medical bills.

Anonymous said...

I must say that I am very grateful to everyone who tried to help my child and hold no anger against UMMC. But BCBS, should be ashamed for denying claims for parents seeking help for their children.

Anonymous said...

You people who seem to think ANY corporation is in business to benefit the customer are sorely misinformed? Why all the negative reactions when BCBS exercises its right to access your pocketbook?

Anonymous said...

Profitable Greedy Insurance companies...a lobbyist dream come me true. A lawmakers dream come true. Lots and lots of slightly regulated unending dollar bills.

Anonymous said...

My husband told me today that we need to switch from BCBS for this reason. We have 3 children that are 15, 12 and 8. We can’t afford to have insurance that won’t cover the only pediatric hospital care in the area. We pay $1300 a month and have been with BCBS for 20 years.

Anonymous said...

05/02, 5.12 PM,

I agree with your closing point that what you describe is the right thing to do. If I am in poor health, a life insurer can rate me as a high risk and charge me more premium than a healthy person. Health insurers (including Medicare/Medicaid) are precluded from doing that - they cannot price risk. This is partially (although not fully) to blame for our ever-increasing healthcare costs.

However, the changes you describe are decades off, if they are ever put into place. If any health insurer - government or otherwise - tries to tell the population how they should eat, drink and otherwise conduct themselves, there will be a massive hue and cry about invasion of privacy, nanny state, yadda, yadda, and lawmakers will cave to this and we will continue with the status quo.

The more likely scenario (and by "more likely" I mean almost-certain) for the next 3-5 decades is that we move to a single-payer system (i.e. the federal government), healthcare costs continue to increase, and the burden shifts more and more to the taxpayers.

Between this healthcare fiasco and the coming tsunami of pension plan failures, the US is hurtling toward welfare-state status. In 30 years, our tax structure and social support system will look like northern Europe.

Anonymous said...

May 2, 2018 at 7:44 PM

Our family had the same conversation. BCBS has changed, even worse, in the post-Obamacare era. We have had our policy over 20 years, 2 children and are paying nearly $1700/mnth

Anonymous said...

Greedy people who can't afford to have children, shouldn't. Their health and education is your responsibility or else you WILL pay the bill, without complaint mind you. A lack of preparation on your part does not constitute a moral dilemma on others. Stop complaining because you can't prevent children from having issues, they just do.....and everyone else is not responsible for them. Sheesh.

Anonymous said...

5:12 has no point. What does grease stained clothes and cars 15 years old have to do with the discussion?

Bravo! Must be a BCBS employee I'm guessing.

Anonymous said...

Predicted to an co-worker yesterday that this one on JJ would draw out all those misguideds who see insurance as some sort of bottomless freeloading piggy bank. Yeah, lets go single payer and watch a nationalized system force parents under the rule of law to watch their children die and restrict their ability to seek healthcare solutions in other countries.

Anonymous said...

who has the worst coverage for meds? Blue Cross
who has the highest premiums? Blue Cross
who demands that their insured get a wellness so they can keep tabs on them? Blue Cross
who sends their medical review doctors to all the professional society meetings to keep the general medical population from openly complaining? Blue Cross
who has a 56:1 reserve for a rainy day? Blue Cross
who has been fucking this state for the last 20 years? Blue Cross

it is high time that the state and industry wise up and drop these assholes, they would quickly change their toon.

Anonymous said...

BCBS is the devil! They have slashed reimbursement for clinical based services and home medical equipment. If you are paying $1200 a month in premiums and for that you want high quality, tough luck. You are going find yourself paying more out of pocket for high quality.

Anonymous said...

Noticed all comments must be approved by the blog author, probably because Blue Cross has control here too. They are afraid their secrets will become public and the executives who are making the heartless decisions and making the big $ will be called out.

Anonymous said...

". Stop complaining because you can't prevent children from having issues, they just do.....and everyone else is not responsible for them. Sheesh"

When you're paying 18k per year for health insurance (plus 12k deductible) and BCBS refuses to cover a child's hospital bill when they get sick; I would say it is the insurance company who is greedy.

We should do away with insurance altogether and then healthcare would be affordable. BCBS pays about 10% of what UMMC bills. Give everyone the same prices that BCBS reimburses and who needs insurance other than a catsrop policy. SHEESH DA!

Anonymous said...

Chaney is a lap dog for BCBS. His Chicken Sh*t statement is evidence. He should have long ago brought his political might to bear to keep BCBS in line.
Instead they have raised your premiums by 40%, deductibles are now routinely $5000, and now they have slashed reimbursement to providers by 50%. That is horrible insurance!!!

Anonymous said...

The reason health care is so expensive is health insurance. Insurers do not care, but want hospitals to charge as much as possible. They base their premiums on these charges so the larger the number, the more money they make. While they only pay the provider a true cost of service which is often 50-90% less than the stated charge. Charge everyone correctly and do away with health insurance.

Drugs are a different story. High prices are often justified if you want research to continue to improve outcomes.

Anonymous said...

At 9:10am That is correct. And that is why BCBS is positioning themselves for the next big market "correction" (i.e. contraction) that will recenter prices to their actual values. If we eliminated insurance, then yes, people would pay their own way in relation to what they could afford, which is the way it should be. Insurance today is really for "peace of mind" in case of something catastrophic, and that model doesn't work for them anymore, and it doesn't promote healthy lifestyles. And government isn't going to bail them out when the next true economic storm hits....and it is coming.

Anonymous said...

People like 3:30 are so jealous of Ole Miss that they'll try to bring the school in on something like this for which they are not responsible. Don't down Ole Miss, 3:30. Just talk positive about your own school. Or is that not possible? Counting down to "I'm not jealous..." Right.

Anonymous said...

@ 3:58----- UMMC is "the only game in town"????? Really?? What happened to Merit Health and Baptist and St. D??????

Further, you apparently do not understand how this work. No hospital is REQUIRED to negotiate with a health insurance company for its payment schedule. No hospital is even required to have anything at all to do with a health insurance company. The hospital provides services to the PATIENT. The PATIENT is responsible for payment. So, if BCBS doesn't want to make fair & reasonable payments to the hospital for its policyholder (the PATIENT), so be it. The hospital can just bill the PATIENT a fair & reasonable price and the SUE him if he doesn't pay up in a timely manner....thereby leaving it up to the PATIENT to get his proper payout from his health insurance company how every he can. And then, when everybody gets sick of trying to collect their from BCBS, they'll start choosing a DIFFERENT health insurance company and BCBS can sit around wondering what hit them.

Anonymous said...

Wait a minute, let me get this straight. As from the comments posted so far it seems that UMMC is the ONLY place in town. I once was a patient with UMC and got the worst service I ever had. I moved on to Baptist and have not regretted it. I also would use St Dominics and Merit Health (which I have) before going back to see anyone with UMC. Some of these comments also seem to say that the only place to get medical care for children is at Blair Batson. Sure, if there is something serious maybe, but their aren't unaffiliated pediatricians in Jackson?

Anonymous said...

People USED to envy going to school in Oxford or being associated with the "rebels"- about 25 years ago. Sorry, but it's not jealousy anymore, it is abject disdain for what they've become. They are dinosaurs in not evolving with the times to be inclusive of and to represent all Mississippians, and the same thing is happening to their precious golden egg UMMC. They've been milking Mississippians for decades, and still seem to believe we're all beneath them now.

Anonymous said...

I've never darkened the door of that facility except for being carried there by ambulance for a traumatic injury event. Why the hell would anybody choose that place for medical care, otherwise? You first have to wade through 'Little Haiti' to get past the bums and then you're lost in a maize of hallways with uncaring people everywhere scurrying all about. It's downhill after that.

Anonymous said...

Hospitals should get their charges in line and quit catering to the insurance companies. $19k for one night for a saline drip and xrays???? $43K for one night and a colonopsy?????$55k to sew up a hand cut by a saw and only 6hrs in the emergency room????$950 for each night in the nursery when newborn stayed with mother both nights?????hospitals deserved to be paid but this shit is crazy. Make it affordable and reasonable and skip the insurance companies instead of conspiring with them...

Anonymous said...

If I'm sick take me to St. D.

Anonymous said...

The Blues are better off, that was their intent.

Anonymous said...

3 comments about UMMC:

(1) stay out of the SICU, particularly on nights and weekends

(2) Stay Out Of The SICU, Particularly On Nights And Weekends!

(3) STAY OUT OF THE SICU, ESPECIALLY ON NIGHTS AND WEEKENDS!!!!

...that is not all, but if you have a choice avoid it all together!

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