Friday, June 29, 2018

Blue Cross & UMMC Go into OT

Insurance Commish Mike Chaney issued the following statement.

I am pleased to report that both BCBSMS and UMMC have now agreed to a mediator suggested by the Department of Insurance in their contractual dispute. The mediation proceedings will take place sometime during the month of July, 2018.

In the meantime, UMMC has agreed to proceed under the contract terms through the month of July, pending the outcome of the mediation. BCBSMS will continue to pay in-network rates as they are now doing. As Commissioner, I appreciate the willingness of both parties to work toward a solution.”

Consumers may contact the MID via email at umcbcdispute@mid.ms.gov or call 1-800-562-2957 if they have questions regarding the dispute.

Meanwhile, UMMC sent this email to its employees:

Last week, state Insurance Commissioner Mike Chaney offered to facilitate mediation between UMMC and BlueCross BlueShield of Mississippi regarding our intent to terminate our contract effective midnight June 30, 2018, if the state’s largest insurer did not agree to a more reasonable contract.

We immediately notified the commissioner of our willingness to participate in mediation. On Tuesday, BCBSMS notified the commissioner that they also agree to have an independent mediator help the two sides work out an agreement. However, they stated they would be unable to schedule a meeting before July 1.

We’ve been in contact with the commissioner’s office throughout the week as part of our agreement to mediate. John Corlew was suggested by the commissioner and agreed upon by us and BCBSMS to serve as the mediator. As of this afternoon, BCBSMS has agreed to schedule dates in July for the mediation to occur.

With the mediation process now underway, we feel we should extend our current contract through July and not go out of network on the first of the month. We are encouraged with BCBSMS’s willingness to come to the negotiation table with a neutral mediator present and will not execute the termination of the contract midnight June 30. This extension allows for the negotiation process to take place outside of the significant disruptions both sides and our patients/members would face in a scenario where the Medical Center is out of network with BCBSMS. If an equitable agreement cannot be reached in July, we will terminate the contract effective midnight July 31, 2018....

32 comments:

Anonymous said...

bad news for greedy BC/BS.

Anonymous said...

I had to threaten to sue them to get a medically necessary PET scan paid for. The only reason that worked is that I am an attorney.

Anonymous said...

BCBS needs some SERIOUS competition. They are full of greed and find every way they can to deny legitimate health care claims.

Anonymous said...

I can only hope this ends very, very poorly for BCBS.

Anonymous said...

Any late word on why Chaney waited so damned long to suggest mediation? Or did have to wait until the contract expired? Whatever, I'm sure we can look for more of his commercials.

Anonymous said...

In the end everyone will see who is actually the greedy one in this situation. Go calculate how much tax payer money gets appropriated by the Legislature each year to fund UMMC just to have them turn around and recklessly spend the money on poor equipment purchasing among many other things. They don’t seem to mind spending someone else’s money. They also demand higher reimbursement for below average medical results.

Anonymous said...

This BCBS in MS has had it pretty easy.

UMC is now in the hunt for cash and the ox is set to be gored.

There is no connect between patient care and actual cost....it’s unrelated.

With the aca on the vent....and the feds tapping out it seems....it’s about to get real.

(Corlew is a great attorney....but why not someone from out of state? - This is just a mediation though)

Anonymous said...

Congrats to our Insurance Commissioner Chaney for stepping in to resolve what BCBS and UMMC were incapable of accomplishing.

Anonymous said...

Insurance companies should be governed similarly to Power Companies. It should be non profit or close to non-profit.

Anonymous said...

BCBS has a virtual monopoly on the sale of health insurance coverage in mississippi. the ms legislature will not do anything about it because BCBS has everyone of them on their payroll. think about it. what other industry in mississippi is controlled by monopolistic competition? NONE! its a stinking outrage.

Anonymous said...

5:17 - Would that be a function of the legislature or the State Insurance Commissioner?

Anonymous said...

I wish I could say this is a battle between two private entities and let them duke it out and the market will decide....but the reality is that one is a government entity and one is a government subsidized monopoly. Great recipe for a quagmire.

Anonymous said...

BCBS reimbursement for physicians is horrible... UMMC is poorly managed I won't dispute that... however, do you remember when JSU was trying to takeover UMMC... that would be lasted 5 min. Every doctor or nurse would be out of there in a month. Gives me anxiety just thinking about it.

Anonymous said...

When my husband changed jobs, our coverage changed from BSBC of MS to BCBS of Alabama.
I was astounded at the difference!
Our coverage increased and cost decreased dramatically. But, the savings in our co-pays on medication were the most shocking as the co-pays dropped as much as $150 on one medication alone!
I thinks that reflects badly on our Insurance Commission's ability to negotiate the best rates for us.
There is absolutely no doubt in my mind that UMMC has been underpaid as I could and did easily compare their reimbursement to UMMC on the yearly testing we need.

I have never had to call BCBS of Ala to argue about approval, but I certainly made several calls to BCBS of MS to over the years I had to put up with their dog and pony nonsense.

Some state variation is justified, but between Ala and MS, I couldn't find a justification for such a dramatic difference.

Anonymous said...

@11:41 PM
"Insurance companies should be governed similarly to Power Companies. It should be non profit or close to non-profit."

In what world are you living to cause you to think that power companies are non-profit or close to non-profit? You need to check annual reports for Entergy and other utility companies. As for making insurance companies non-profit, can you say "single payer system?" If you thing insurance is bad now just wait until the government takes it over. Oh, wait! We tried that didn't we. I'm as disgusted as the next guy about high health insurance premiums ($1,138/mo for me alone) but the answer is not to have universal health care and not-for-profit insurance companies.

Anonymous said...

Easy solution... allow insurance companies to cross state lines. Create competition and Mississippi BCBS will have to adjust or die out. The free market will always win...

Anonymous said...

@ 9:14,
The lower premium and copay amounts you are now experiencing are likely due to your husband's new (more generous) employer. Most employees only pay some fraction of the actual cost of their coverage, with the employer footing the lion's share of their bill. (Ever hear people bitch about sky high COBRA premiums? COBRA is the actual cost of coverage with no employer subsidy).

With that being said, my employer provides me with PPO coverage through BCBS of Texas. We've never had any drama with major health providers in MS quitting our network like BCBS/MS does. The worst we've had happen is an occasional pharmacy dropping out (my husband takes a rarely stocked medication), but that's pretty easy to work around.

I don't know why BCBS/MS has so much drama with MS healthcare providers, while BCBS/AL and BCBS/TX don't. Just glad I don't have to deal with it!

Anonymous said...

9:14 am

Agreed.

I noticed the same thing.

BCBS of Alabama is far superior to MS.

Guess it may have to do with payor mix?

Dickie V. said...

O.T.? Awesome Baby!
UMMC wants to be the P.T.P
But Blue Cross is going to be Mr. Pacman BABY!
UMMC gonna get a Wilson Sandwich BABY!
O.T.? HA! between these two it's more like sudden death
if you don't get admitted via a helicopter BABY!

Anonymous said...

"Some state variation is justified, but between Ala and MS, I couldn't find a justification for such a dramatic difference."

Mississippi is the only state I have ever lived in where BC/BS is in the private or "for profit" sector. Everywhere else it has been a non-profit operation. Is BC/BS of Alabama a non-profit organization? The greediness of BC/BS of Mississippi was startling when I first enrolled my family in it in 2000.

Anonymous said...

9:29

We are gonna get a chance at your way....you will enter the ER through the bankruptcy court.

Anonymous said...

@9:29

When did the government take over healthcare? A bill designed by insurance providers to cement themselves as the middle man forever, and call it Obamacare.

I know this is considered communist or socialist, but socialized medicine cuts out a massive amount of waste. The health insurance industry is a leach.

Anonymous said...

Big Pharma, insurers, kick backs to physicians, hospital billings, private investment groups taking over life saving drugs, etc... the whole industry is corrupt but that is business in America today!

Anonymous said...

Blue Cross Alabama has lost hundreds of millions of dollars the last few years. Maybe Blue Cross Mississippi doesn’t want to follow their lead

Anonymous said...

@2:44
Yep, no waste at the VA.

Anonymous said...

9:53 am

Do you have a citation for your statement that BC Alabama has lost hundreds of millions over the last few years?

My research does not show that at all.

?

Anonymous said...

If I were in the Legislature and wanted to make a name for myself, i would pull the rug off BCBSMS and let the sunshine hit the back of that roach. They have spent the last 10 years increasing premiums and co-pays by 50%, let the dust settle for a year, then cut provider fees by 50%. Where is the money going? Who is accountable for checks and balances?

Anonymous said...

I would love to see a breakdown of BCBS of MS membership detailing how many members are ACTUALLY FULLY-INSURED by BCBS of MS. MOST people pay their premiums to their EMPLOYER who uses that money to pay the company's medical claims. Their EMPLOYER decides their benefits and sets their premiums (BCBS only serves as the claims administrator... for a fee or %.) If you work for a government entity, you are not fully-insured through BCBS... you are insured by your government employer. If you work for a mid-to-large corporation, you too are likely insured by your company, not BCBS. If more people actually understood WHO decided what their insurance benefits and premiums would be, they might be visiting their HR departments instead of bashing BCBS. Also, whether your company insures you or you are fully-insured through BCBS of MS, the premiums are based on previous claims paid and risk of future claims paid. (Stay out of the drive-thrus and put down the cigarettes and drinks.) Also, as far as checks and balances... do most of you even understand that BCBS is fighting UMMC to keep the allowable rates DOWN directly affecting its members by costing them less co-insurance/out-of-pocket??? Why are so many people screaming to pay more money?!? Higher rates will also cause what your employer or BCBS pays out and WILL MAKE YOUR PREMIUMS CONTINUE TO RISE YEAR AFTER YEAR! Think folks!!!

Wow said...

The ignorance of people on here is hilarious. A very small % of UMMC's yearly revenues come from the State.

People are commenting on here like UMMC's entire budget is state appropriated.

Kingfish said...

When you throw in Medicaid and Medicare, well, a good bit of their income is funded by the taxpayers in some form or fashion.

Not to mention their damn benefits are covered by PERS.

Anonymous said...

On January 1, 1996, BCBSMS, the Company converted from a non-profit membership corporation to a mutual insurance company, and the name of the Company was changed to its current title, Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company

Anonymous said...

A mutual insurance company is owned by its members. Each member should have an account in their name with an equity balance that belongs to that member. The member should get an annual statement of the balance and a small annual payment of their equity. Does NCBSMS do this?

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