Friday, April 1, 2022

Kicked to the Curb

 The University of Mississippi Medical Center issued the following statement. 

The University of Mississippi Medical Center’s contract with Blue Cross & Blue Shield of Mississippi ended at midnight March 31, meaning the state’s largest insurer has forced from its network all of UMMC’s hospitals, clinics, physicians and other providers statewide. Also impacted are members of Blue Cross commercial plans from other states and those on a Blue Cross federal plan.

Blue Cross has refused to bring the Medical Center’s reimbursement closer to fair market rates after underpaying UMMC by tens of millions of dollars per year, for many years. Blue Cross’s lack of good-faith negotiating shows it is unwilling to value the unique and vital services provided by the state’s only academic medical center and safety net hospital.

Now, thousands of patients needing specialty care and unique services only offered in the state by UMMC will pay higher costs because they are no longer in the Blue Cross network. Over the past 18 months, UMMC has treated more than 50,000 patients who have a Blue Cross commercial health insurance plan.

Some may have to leave the state to seek services they have depended on at UMMC – for example, organ transplants or specialty care for infants and children with complex or rare diseases.

“We are disappointed that Blue Cross doesn’t value the Medical Center enough to agree to a fair contract and keep us in its network. We know that patients are disheartened and frustrated,” said Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the School of Medicine.

“We must – for the health and wellness of all Mississippians – stand firm in our resolve that Blue Cross should agree to pay us at fair market rates.”

The Mississippi State and School Employees Health Plan, which is administered by Blue Cross & Blue Shield of Mississippi, is not part of the terminated contract. UMMC is still in network for patients who have that insurance.

Patients receiving emergency care will continue to have in-network rates. Patients currently receiving care or treatment at UMMC for a specific ongoing medical condition or conditions based on federally determined qualifying criteria will continue to have in-network coverage for a temporary 90-day period, ending on July 1, 2022.

More is at stake than Mississippians’ access to specialty care and unique services.

UMMC “must have the financial ability to reinvest in the health of the state,” Woodward said. “We must have fair reimbursement so that we can provide the services, programs and facilities that patients and families need and must have, now and in the future.

 “Blue Cross has been unwilling to value our unique, vital services that Mississippians depend on,” she said.

Those unique services include the state’s only Level I trauma center, only children’s hospital, only organ and tissue transplant program and only Level IV neonatal intensive care unit. UMMC treats the sickest of the sick, including dozens transferred daily from hospitals that don’t have the specialty care needed for the traumatically injured and those with the gravest illnesses.

Although Blue Cross contends UMMC is no different than any other hospital in the state when it comes to reimbursement, “there are no other hospitals in the state like us,” Woodward said. “We should be compared to other safety net hospitals and academic medical centers just like us, not smaller community hospitals that just don’t care for the same types of patients we do.”

The Medical Center has asked to be funded at the level of comparable academic medical centers in regional cities such as Birmingham, Memphis or New Orleans. UMMC requested a 30% rate increase “that moves us closer to – not equal to or more than – market rates,” Woodward said.

UMMC is the state’s largest producer of specially trained health care professionals and home to the state’s emergency medical services center. It is a vital component of the state’s network of hospitals and health care providers.

“Blue Cross has indicated that they don’t value us in their network and don’t need us in their network,” said Dr. Alan Jones, associate vice chancellor for clinical affairs. “The biggest impact of us going out of network is access to care that only UMMC provides to patients in the state of Mississippi.

“It’s disappointing that Blue Cross believes that it’s okay for some patients to drive out of state to get the care they need, even if doing that causes these patients financial or physical hardship.”

Updated information on how the contract’s expiration will affect patients can be found at UMMCCares.com. Patients can also call a dedicated line, 601-496-0008, with questions.

 

33 comments:

Anonymous said...

Bye Felisha

Anonymous said...

One point for UMMC getting a jump on the PR battle.

Anonymous said...

If you haven't figured this out by now Blue Cross is ruthless. The only thing they are concerned about is the bottom line. Their management and executives make tons of money on the back of sick people. It's really sad. I am lucky that i am on the state employees plan so i can still go see my doctor.

Anonymous said...

Hospital leaderships fault. NOW you will see MASS layoffs within the hospital systems due to DOCTORS leaving. Not to mention all the CANCER patients now twisting in the wind ! What in Gods name is State leaders doing leaving these people in place ? WTF.

Anonymous said...

I am confused. Is UMMC saying that because of their ability to provide so many special services, that they deserve to be reimbursed at a greater level? If that's the case, then I disagree with them. If your go into any hospital for gall bladder surgery, then I believe that the reimbursement should be the same no matter where you go. For the services that UMMC provides that no other facility can provide, then yes, that should be taken into consideration.

Anonymous said...

Both entities are in error. Cancer patients are the ones getting screwed here.

Heavytoast said...

A couple of points. UMMC is not exactly comparable to StD or Baptist. A more accurate comparison would be UAB, university – NOLA, Region One Memphis,etc. Those Eurocopters flying over my house are rarely headed to St D or Baptist. Blue Cross reimburses academic medical centers all over the country at roughly 200% of Medicare rate I’m told; with the exception of ding ding ding - Mississippi. The engine of greed is not fueled by 200% of Medicare rate. Ok monkeys, let the poo fly! Ready? Go!

Anonymous said...

If you think their business tactics are ruthless, you need to talk to someone who works for them. They are a mini concentration camp. They are harsh on their employees. They won't even allow an employee's spouse to pick them up for lunch from the premises. There are other horror stories of micromanagement.

Anonymous said...

@10:20, are you speaking of UMMC or BCBSMS? If it is BCBSMS, it is a concentration camp and I escaped several years ago. There is nothing they can do that would surprise me.

Anonymous said...

BCBS refuses to grease those MS palms to make things happen, right?

Anonymous said...

Why does UMMC deserve an above local market reimbursement rate? Who is going to end up paying for the higher reimbursement rate? I bet it is the policy holders that end up paying higher premiums to cover the increased cost.

Anonymous said...

Maybe BCBS should get it’s own house in order before it starts getting in other peoples business. I handled my mom’s insurance before she passed away. She had Alzheimer’s and she had Medicare and a secondary policy through BCBS and the state employees retirement system. The BCBS policy had been in my stepdad’s name until he died 6 months before my mom. During the most stressful period of my life, while taking care of my mom in a pandemic, BCBS denied claims for my mom, putting them under my stepdad’s policy number (which no longer existed due to his death.) They blamed me, the physician’s office, hospitals, Medicare, anyone but themself. They said it had to be us using the wrong number. I called repeatedly since this happened on every claim, only to get blamed and they said they were not at fault this is called a changeover and BCBS is supposed to handle this.) Finally contacted Medicare and it turned out BCBS had not notified them of my moms change of policy number after my stepdad’s death. After many phone calls I finally got BCBS to start fixing this and it still took more phone calls and two months before it was fixed. Unfortunately mom died around that same time. I also found out that it wasn’t just my family that was affected but others had this issue too.

My mom received excellent care from physicians, hospital staff at multiple facilities during a pandemic as she suffered from Alzheimer’s. Can’t say the same for BCBS and how they handled this issue. If you have elderly parents who may be beginning to have cognitive issues, please make sure they are not having a similar issue and that BCBS does the changeover. I would hate for anyone to go through what I went through.

Anonymous said...

Does this mean that in the event that something horrible happens and I am flown over to UMMC. BCBS wont cover that?

Anonymous said...

Single payer healthcare is the only issue I agree with the liberal leftists on because of this issue right here. Hospital billing and Health Insurance Companies are BOTH corrupt. It is all profit driven - don't let anyone tell you otherwise. There are no 'good guys' in this situation. I can't wait for the day health insurers like BCBSMS are shut down for good. (FYI I worked for a health insurance company.)

Anonymous said...

@12:58 Call 1-800-898-7797 and speak with a rep. There is a lot of misinformation out there and BCBS are really the only ones who can say what they will cover/pay.

Anonymous said...

12:58 : Who knows. One thing is for sure, those trauma nurses and doctors won't be there to help you. Not the good ones. Thank LouAnn

Anonymous said...

It sucks that our medical costs have to be inflated enough to pay the massive middlemen insurance companies. Unfortunately, they know how to pay off the right politicians to keep their scam alive and well. Costs will continue to rise and politicians will keep getting paid to vote against our best interests.

Anonymous said...

There are no winners in this fight. UMMC is as greedy, incompetent and inefficient as BCBS. For every BCBS horror story, there is one just as bad coming from UMMC. It is hard to take their side in this fight when they can't seem to clean up their own shortcomings.

Anonymous said...

BCBS Is about TO PAY OUT $2.67 BILLION...THATS BILLION WITH A B, in a a class action suit in an Alabama federal court for violation of federal antitrust laws and screwing policyholders.
here's the good part....nowhere in the settlement does BCBS admit they did anything wrong.
tell me, if you insisted that you did nothing wrong, would you pay out $2.67 billion?????

Anonymous said...

BCBS ARE RIGHT UP THERE WITH THE GAMBINO, luchasse, bannano and columbo crime families.
they are protected because they have greased every politician in this stinking 3nd world cesspool called mississippi

Anonymous said...

Wouldn't take a stray dog to UMMC. Screw them and their leadership. Cancer patients can find another doctor. I know because I did. Health care in Mississippi is the worst in the country anyway. I leave the state for care.

Anonymous said...

Blue Cross has a monopoly in Mississippi.

Anonymous said...

Sadly, the McCarran-Ferguson Act exempts much of the insurance business from federal antitrust liability.

Anonymous said...

@11:47am No disrespect to your parents but stop the boohooing.

So, you just gave a synopsis of taking care of your elderly, rapidly declining parents...big whoop. Welcome to the club fella. It's called life...and all you found out - and that millions of others discovered - is that private insurances AND Medicare don't really pay for end-of-life care. It's a fact.

Billions worldwide are going to succumb to Alzheimer's (both of my parents did) and the healthcare industry knows it - but there is no treatment except to keep them comfortable, because they aren't ever going to improve/recover - so it's a terminal prognosis. So, insurance money stops for anything significant, including nursing home care! Those billions of people will be caring for the parents AT HOME which is an ugly proposition if you've been in that situation with zero savings. There is no answer. The Alzheimer's Tsunami just over the horizon is real - and it would bankrupt the nation's insurance carriers and federal government if they even tried to cover the costs.

So, stop whining about who didn't pay for what. There's no romance without finance in life across the board. It's a hard reality too few understand.

Anonymous said...

"Does this mean that in the event that something horrible happens and I am flown over to UMMC. BCBS won't cover that?"

UMMC will treat you, but UMMC won't get paid because they're too greedy. Please connect the dots properly.

Anonymous said...

2:51 poses a good question.
i would think the the brilliant keyboard cowboys of jj would be able to answer up on that one. after all, you cowboys are all educated at and are part of the beautiful people of the SEC and i would think that you would at least know where a place called alabama is.

Anonymous said...

to all the UMMC haters on here, the next time you get sick or injured maybe they can send a BCBS executive in to treat you rather than a UMMC doctor.

Anonymous said...

"Why does UMMC deserve an above local market reimbursement rate? "

How else would you suggest they support the state's only Level 1 Trauma Center? Should they have a tip jar at the door so grateful patients can toss in a few bucks when they are discharged?

Anonymous said...

There are chronically ill children in this state whose only option for certain specialties is at UMMC, and these specialists provide excellent care. The only other option is to go out of state for care. Some of you will say better to go out of state. Well then you haven't lived it and I hope you never have to. UMMC and BC are both at fault here. UMMC just basically gave many of its most vulnerable patients the bird. Shame on all of them.

Anonymous said...

BCBS is not at fault here. Period.

UMMC is about to get over a $100 million in ARPA money that it never even needed, and no one will ever account for the other $100 million in bonus federal money they got for patients they gave bogus Covid diagnoses.

Anonymous said...

UMMC can give a Unique experience. Was in ER years ago after MVA. Fortunately I wasn't serious enough & they didn't gave a Room, so I was in Hall on gurney. A group actually got in a fight I n the ER & a gun was Pulled. Fortunately the Gunman was young enough & not seasoned, that when they said they were calling Security, he fled. About 15 minutes later after Security was sure he was gone, did they finally show up, Really stays as a Lasting Memory.

Anonymous said...

10:02: No, that's not what they are saying. UMMC is getting reimbursed LESS THAN St D, Baptist, etc. As someone else posted, the true comparisons are UAB, etc, and UMMC gets MUCH LESS than those institutions.

Anonymous said...

9:36 ... in many, many cases the BCBS rep would know more. maybe they wouldn't falsify records daily. Where is the accurate covid count of who died 'with' or 'from'? Where is the accounting from UMMC. Wouldn't take a stray, blind dog to that place.


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