Jackson Jambalaya

Insurance companies are much like Tobacco companies and Mississippi politicians, if they speak, they lie. To boot they will do anything to get your money.

Why should Mississippi taxpayer pay for this defense and settlement if they did lie ?

They are suing the individual UMC employees, not UMC. Typical BCBS and Brunini intimidation.

Blue Cross=Bull Chit.

Wanna know why health insurance rates are so high? Go look at the parking lot at BCBS..

I don’t know if it rises to the level of defamation, but BCBS is right. I am in the healthcare business (provider side - not the payer side). These negotiations happen all the time. BCBS has no incentive to “force UMMC out of its network.” They simply haven’t agreed to increase their rates to the level UMMC is demanding. If UMMC is unwilling to accept BCBS rates (either temporarily during negotiations or permanently), it is their choice not to accept BCBS patients.

I don’t know if the rates BCBS is offering are reasonable, but they have offered something and are willing to pay UMMC. It was entirely UMMC’s decision to go nuclear here.

The reason the UMMC ad campaign stings so badly - prompting this suit - is that the provider (UMMC in this case) always has the upper hand. They are the ones that have the relationship with and are actually taking care of the patient. The perception (maybe reality?) is that the insurance company is only about the dollars.

Note Kingfish’s highlights about UMMC’s refusal to accept the incentive payments based on quality measures. These incentives are very common in the industry now. They make sense for everyone: the patient gets the care they need, the provider gets paid for providing the care, and the insurance company is paying for something that data show will improve patient health and reduce costs overall. These are things like proving mammograms to women over 40, A1c blood tests to diabetics, chest x-rays to smokers, etc. These aren’t complicated quality measures. It’s telling that UMMC is reluctant to agree to these but instead is willing to go to the mat for guaranteed fee bumps with no accountability from their side. In fairness to UMMC, considering the characteristics of much of its patient population - poor, uneducated and largely unconcerned about their health - even hitting the simplest of measures is probably a monumental task.

Not to throw fuel on the fire, but if I need my gallbladder out, why should UMMC be paid more than St. Dominic for the procedure?

No provable monetary damages. BCBS's reputation has been in the toilet a very long time.

Ridiculous! BCBS increases premiums at an exorbitant rate every year. It then keeps reimbursement rates low and makes money coming and going.

It may be different today, but a couple of years ago, the ambulance company Madison County contracted with was not in (excluded from) the Blue Cross Network.

For whatever reason, and the patient has no choice as to ambulance, if you got a ride in that service, you paid 'out of network (exorbitant) cost' for your ride to the hospital.

Whose 'fault' was THAT? On a smaller scale aren't both these scenarios 'apples'?

In my opinion, when a county advertises for ambulance service bids, one requirement should be 'MUST be in major plan networks'.

And this is why MS needs competitive hospital networks. I have BCBS, and did my diligence to avoid UMMC after things went awry. I was recently seen by a specialist in the Baptist Hospital network, and thought I was in the clear.

Apparently, UMMC radiologists are short of work and are getting radiology exams sent to them for reading/interpretation. I ended up with an out of network charge for that reading. I'm fine with business disagreements, but do not go hunting for customers that are avoiding you.

Interesting to see what BCBS does with rates this year. They hold reserves far in excess of other health insurers, including other Blues, but continue to raise rates. As a mutual insurer, they should be passing more in excess of reasonable operating expenses and sensible reserves to policyholders/subscribers in the form of lower rates, or at the very least staving off increases. Not to “defame” them (Who knew they were so sensitive), but it sounds to a layman like they are screwing their subscribers.

As to this dispute- are they offering less in reimbursements than the other insurers that are in network with UMC?

UMMC/Oxford sounds like a spoiled/whiny adolescent in this scenario:

"Take care of me! Pay for everything I want and think I need! But leave me alone and stay out of my business!"

Jees, UMMC gets well over a billion a year from the state alone.

BCBS MS is a great place to work. Some of the highest upper management salaries in the state! Seriously, they pay extremely well!

When the majority of the American public starts being in favor of single payer healthcare it will be because of crap like this. The way we pay our medical system through insurance has to be the dumbest thing I've ever seen. Unless you're in the business, you need an interpreter to explain your billing statements and why insurance paid for what it did or didn't pay for some things.

All hat- no cattle.

It's greed pure and simple. How are the multitude of other private hospitals and practices in the metro area making it without any of these kinds of fallouts, yet the state funded UMMC is trying to force BCBS's hand and make them pay UMMC more than anyone else. This reminds me of a certain local body shop that tries to force insurance companies to pay more in labor rates than damn near anywhere in the country and they are located in Florence and Clinton because they think they do so much better than anyone else. You know they one who's owner actually ran for insurance commissioner so he could move the needle in his favor because he takes pride in perfection. Anyway, every other body shop in the state says they make plenty of money at the current negotiated rate yet he is demanding $90/hr labor rate while the rest are cool with $65. Greed pure and simple. I can assure you UMMC and the body shop mentioned are not passing down their demanded rate increases to their employees. UMMC has some of the best providers in the state, but the administration since the Dan Jones era has tried to run the place in the ground.

One greedy crook bitching about another greedy crook. It would be funny if it weren't so sad. This crap gets so old every damn year.

How could BCBS's reputation ever be harmed worse than it already is?

@6:11

How is the fault of an insurance company when you are charged over $70,000 for outpatient knee surgery?

Insurance is not a right it's a choice and if you hate insurance companies so much then don't buy their product.

The admins at UMMC who are in the public eye because of this all need to be fired. Not long ago, it said in the student handbook that if a student made defamatory statements on social media, they could kick him/her out. Goose meet gander you asshats.

All the other providers are secretly cheering on UMMC. If UMMC gets its way, the other providers will demand equal treatment. And they all HATE BCBS with good reason.

Both sides suck, and the only losers here are the patients.

Mississippi desperately needs an Anti-SLAPP law.

Not participating in Medicaid expansion has really hamstrung our state. UMMC and other providers have to cover those losses somehow and it’s not fair to the insured patients who have to pay more. The entire health insurance model is unsustainable. There’s also this little issue for bsbs: https://mississippitoday.org/2022/04/25/blue-cross-is-sitting-on-a-huge-pile-of-money-in-some-states-consumers-would-get-it-back/

Both UMMC and Blue Cross have acted pretty awful.

But FOLLOW. THE. MONEY. That money that UMMC spent on attack ads and hit pieces is peanuts compared to the dollars really at play. And everyone knows it.

7:18 am As a "victim" of this battle, please explain why, as an Alabama BCBS insured why MS BCBS does the " paperwork "now and my colonoscopy was not covered in full as a need test for someone with familia polyps.
Please explain why I have to go to "approved" doctors, and the list sent to my employer was for family MDs and internists only? Most on the list were " doc in a box" and the few who had board certification weren't taking new patients.
I did as MSBCBS " instructed". My blood pressure and heart rate and temperature was taken. I had to ask for a crucial test. It's good I did or I'd be dead now. As it is, I'm having to take a LONGER time getting well because the gel form I absorb more quickly is no longer covered.
Their network ( unlike UMMC's) doesn't monitor the medications a patient is taking so when I was prescribed two that shouldn't be taken together, no doctor in the BCBS " network" noticed.
I was living a very active life with the cooperative UMMC system where each doctor had my complete medical history at their fingertips and knew " specialities" overlap. This fiasco when BCBS prevented me from being able to afford the monitoring that kept me that healthy!
I'm old enough to remember when I could pick my already licensed physicians and insurers covered what care was provided. I considered that something done in country that values freedom. I don't want "bean counters" making my health decisions!
A warning to doctors, you think you didn't want the government to tell you what you can earn? Just wait until you are ALL working for BCBS!

Looks like Lou Ann has over played her hand, look for political fallout.

It is truly stunning how many people do not understand this scenario and/or how their insurance works.

1. Lower allowed rates means LESS co-insurance out of YOUR pocket. BCBS is trying saving YOU money!
2. The majority of people are not directly insured by BCBS. Your EMPLOYER collects your premiums and pays your claims… not BCBS. Your employer also decides what is covered under your plan… not BCBS.
3. If you are employed, YOUR EMPLOYER is setting your premium and raising your rates every year… not BCBS. Said rates are raising annually because YOU AND YOUR COWORKERS ARE COSTING YOUR EMPLOYER MORE MONEY. Do you know what keeps costs down? Lower allowed rates just like BCBS is fighting UMMC for. (Fun fact: your employer is also the one raising your deductibles and out of pocket limits.)
4. BCBS is not refusing a single soul a covered service… that’s all on UMMC.
5. BCBS has a huge reserve because it’s leadership (for decades) ran a super-tight ship. If you worked there 20 or so years ago, you KNOW!
6. The doctors all “hate BCBS” crowd sounds silly. Of course they hate the insurance companies because they limit what the doctors and hospitals can squander from you in your time of desperation. And the doctors don’t want to admit they don’t like being limited on how much they can charge you/your employer for services.

@9:32a-
Since you have BCBS AL and live in MS, it’s safe to assume you’re covered through an employer. Here’s a reality check for you… your EMPLOYER decides what’s covered and what premiums you pay… not BCBS. Don’t like it, go to HR. They will lie and blame BCBS, but that’s just it… your employer is lying to you. Your employer controls everything, BCBS is simply administering the contract terms your employer decided on for its employees.

Also, all state BCBS plans are individual companies, but they cooperate with each other to process claims for providers in their state networks. This is good for you. Your current problem is your provider/doctor is refusing to treat patients within any BCBS plan. BCBS is not your problem.

"O where, O where is Mike Cheney now?
O where, O where could he be?
In Sandestin spending his 50% pay increase,
how nice if Cheney would end this mess."

I'm a conservative, but I think I would vote for freaking AOC before I'd vote for Mike Cheney.

As Pogo the cartoon character once said, "we have seen the enemy and he is US".

Lawsuit is bogus

Actual malice cannot be proven on these set of facts

Waste of time

Will be dismissed shortly

The person behind this attack ad scheme wasn’t anyone mentioned in the suit. It was Nelson Weichold, CFO. He should be the only individual named and held responsible.

Is Carol Pigott from Tylertown originally? (a Mary Carol Pigott graduated from Tylertown High in the early 1970s). If so, I'm curious as to how she made the professional transition from high school teacher to President/CEO of BCBS.

Insurance of any kind is the biggest scam ever perpetuated on man. We are so gullible.

@10:09am - Hello fellow BCBSMS executive.

11:28
Yes, it is one in the same.

Insurance is socialism. But y’all love that shit, just won’t admit it.

@12:45 PM
As an affluent banking family of pedigree, I prefer all my profit to be privatized and all my loses to be publicly subsidized.

BC/BS of Mississippi is the only BC/BS plan I know of that is a FOR-PROFIT company. Every other one is a non-profit. How this affects the current controversy is not clear but very suspicious nonetheless.

10:09 - your comments are wrong on so many levels - BC insured patients must follow the medical and reimbursement policies regarding amounts paid. The employers do not dictate what is covered or at what rate the providers are reimbursed. BC has a division that performs third party administrative agreements for the small number of self insured employers within our state, but those are a small percentage versus the fully insured companies they work with. Both fully insured and self insured companies are bound by the BC coverage amounts, covered procedures, and reimbursement guidelines.

Additionally, all BC groups (either self insured or fully insured) are bound on pharmacy contracts, eligible medications that BC has contracted with. They can't set their own eligible prescriptions. The contracts that BC works with their approved pharma give them (BC) a percentage reimbursement that isn't passed back to the company providing the insurance for their employees.

In summary, BC is taking from the employers/employees contribution amounts and keeping the additional revenues for themselves. Their reserves are way above other BC groups. It needs to have a review from whatever state/federal agency regarding the way they run their business, It seems that they are covered somehow as a "mutual" company, but it impacts about 35 to 40% of covered individuals in the state.

So many experts...So many rear-entries without lube.

@1.14 PM

Many BCBS plans/entities are for-profit. Anthem, a publicly-traded, for-profit company, owns 15 Blue Cross plans (MS is not one of them).

Even if BCBS of MS were not-for-profit, it probably would make little difference in this case.

Not participating in Medicaid expansion has really hamstrung our state.

Not participating in Medicaid expansion because of racism when it was their own race, political party and corrupt politicians stealing the welfare for themselves.

@1:42pm You're talking out of your ass. Just your simple phrase "The employers do not dictate what is covered or at what rate the providers are reimbursed" explains how little you wish to admit. No shit the employers don't dictate - they don't have the money to. In case you haven't heard: "Those who have the gold, make the rules".

UMMC can participate or walk away. So, UMMC has walked away from the table, and stopped providing services, and won't get paid - so much for a commitment to serving the community as a non-profit. That's how it works, and UMMC refuses to grow up - that is so Oxford.

Medical types altogether hate this reality. I've been in meetings and seen doctors and nurses throw up their hands and walk out of a budget meeting saying, "I went to school to help people! WHY do I have to talk about this?!?" All their do-gooder wishful thinking is subsidized by who? They don't care. Just let me make lots of money and work in medicine.

By the way, BCBS has the largest reserves in the nation, because its customer base is quite literally, and in fact - the unhealthiest in the nation. So, there is a justification. BCBS's reward is for taking the risk. No one else is clamoring to underwrite the healthcare for Mississippians.

@1:42p- 10:09a here…

You are mixing apples and oranges.

Apples: The employers most certainly dictate what procedures are covered, the processes and appeals to cover those, the premiums, deductibles, and out-of-pocket amounts. Any employer contracted with BCBS can absolutely approve to pay whatever the hell they want… it’s their money being spent. The employer funds the claims (dollars paid out), not BCBS. Most all CHOOSE BCBS’ existing network and provider agreements to keep their (employer) costs down/contained. (BCBS makes most of their money ADMINISTERING plans, not insuring people.

Oranges: The allowed amounts and networks are in place to provide overall less costs to subscribers/ insureds. The employers are saving TONS with the provider agreements with both doctors and pharmacies. What part of this is confusing to you? If a doctor decides to charge $2,000 for a procedure, but the allowed amount is only $1,000, the employer will be out $800 and the insured $200 based on traditional 80/20 coinsurance, with the provider writing off the overage. Without the provider agreement, the employer would pay $1,600 and the insured $400, with no cap on charges for future procedures. There’s absolutely no sane argument against containing amounts allowed for procedures or medications.

BCBS adjust premiums for those directly insured each year based on costs (just like employers do.) Look around MS… lots of overweight, sick people and many providers ordering TONS of unnecessary procedures.

@11:55a- Definitely not an executive, but I did work there decades ago for a short time. It’s a strict-run, no-nonsense company who protects their assets. They don’t owe anyone their savings when they’ve worked hard to build them. I’m grateful to have learned how insurance actually works, because 99% of folks don’t have a clue!!

Insurance companies should be made subject to antitrust laws.

10.09 is full of B.S. She works for blue Ross. I’m a doctor and pay for blue cross for my employees. They never ask you to choose what’s covered. Furthermore, BC of Mississippi doesn’t cover things that BC of Alabama and Louisiana routinely cover. They love to say it’s the employers choice. However, when you call to ask if this code is covered they say not. Funny how no employer in Mississippi chooses that coverage but every employer in Alabama does. They are evil SOBs

@9:09p- No, I don’t work for BCBS. Also, I’m not buying that you’re a doctor based on your grammar and poor understanding of insurance.

If your practice is self funded, you can most certainly tell BCBS what to cover. HELL, since you want to cover everything, just pay your employees’ medical expenses directly to their providers and skip the insurance all together. We all know you won’t do this because you’d be eaten alive in health care costs for your employees. You choose a cozy, protective package with exclusions from BCBS then try to blame them when something is “not covered.”

As far as covered procedures, whether or not a procedure is covered is stated in each and every policy. You should understand the lingo enough to be able to decipher whether a code/procedure will fall under the covered column or the excluded column. Even over 20 years ago (when I actually did work at BCBS), most denied procedures/expenses were due to the provider using the wrong code(s) for the actual service requested/performed. But even then, you can either correct the claim or appeal and argue medical necessity. The reality is that you doctors HATE correcting your errors and explaining why you want to experiment with “new” procedures.

I’m laughing out loud at your BCBS AL and LA claims. Folks in those states bitch and moan just like folks in MS. There are thousands of different coverage contracts within each state. You comparing coverage from a few patients proves absolutely nothing.

Funny thing is that those of us who understand insurance think the PROVIDERS (you) are the evil SOBs. Your charge WAY TOO MUCH for your services. Deep down you hate BCBS because they protect their subscribers from you escalating their out of pocket costs on a whim.

One interesting question. Are BCBS executives bonused based in part on denials of test or coverage?

1:14
BCBS of MS does legally hold a not-for-profit status but is a mutual company. Members ownership is held in the reserves ensure members claims are paid. I am not an attorney, so I don't understand how both can be, but it is. That is a legal fact, even if no one likes it.

@11:26am

BCBS of MS is for-profit, and the BCBS of MS Foundation (501c3) is non-profit. Prove me wrong. If the former has any non-profit status, point to where that's to be verified. Please.

10:09
I DO understand "how it works".
You don't seem to understand that the "employer" has no ability to negotiate since there is little competition in MS and when they did get better in Alabama, you succeeded in taking over billing and payment for ALA BCBS.

SO PLEASE, be honest! My co-pay going up or down is in YOUR hands as you offer or don't offer what you f'ing please with our Insurance Commissioner's blessing.
More importantly, you no longer ( thanks to a lame duck Congress long ago) have to report your profits and loss and be accountable for it. It's propriety information and you volunteer information that isn't confirmable.

And, you probably weren't even born when health insurers could be held to be held accountable!

I can't get the best health insurance available IN Mississippi. They are not approved to compete here except for life, automobile and homeowners insurance!
I even understand " pools" but if you are going to "pool" Alabama and Mississippi, the insured should benefit!

You are like the fools who sympathize with a catastrophic event payout and forget that an insurer gets premiums for decades that are supposed to be well enough invested to cover catastrophic events. That's how it worked for centuries when you didn't have gamblers investing the money!
You are likely like the oxycontin saleman who believed it wasn't addictive!
God save us from the deliberately blind and dumb!

No one asked me or my employer about " co-pay" increases.
I already avoided "co-pays" on medicine because the pharmacy at UMMC is not restricted in purchasing medicine as pharmacies are.

I could get my medicine for less than my co-pay once I learned how much cheaper it was at UMMC.

I've paid high premiums for over 55 years to BCBS and rarely met my deductible. I've still not cost you for anything except yearly check ups and the occasional minor outpatient procedure.
What the hell did you do with my money? You were supposed to invest it wisely and conservatively, not play fast and loose with the stock market! You weren't supposed to get top heavy in management. You weren't supposed to pay bonuses when you lost money.
I've no sympathy for you! You have been dishonorable in your greed!

The TRUTH is that UMMC is not more expensive than St D's or Baptist.
The TRUTH is that the co-pays aren't different.
Some of us have lived long enough to have been treated at all 3.

Also, you " the State gives money to UMMC" people, much of that goes to train doctors and residents and their professors. It's one of the ways you get good doctors to live here when they could earn far more elsewhere.
BCBS is selling you a bill of goods and trying to muddy the water!
They know they can't take on the Catholics or Baptists, but they can they can take on anything government related.
If you are going to look for conspiracies, please do follow the money to at least see where it's going. Is it going into a fat cat pocket or is it be used to improve your circumstances?

UMMC apparently wants Blue Cross to subsidize them for the many patients that don’t have insurance and don’t pay a dime for their services.

4:14pm You're talking about things you do not know.

St. Dominic and Baptist are just patiently waiting to happily absorb UMMC's business...it's only a matter of time. Oxford/UMMC isn't the 800 lb. gorilla in the room anymore...they're overextended, and as someone previously said - are deliberately trying to engineer BCBS to subsidize their never-ending dreams of expansion and increased salaries through stoking and then leveraging the public's fear. It's despicable.

Perhaps court-ordered arbitration will sort it.

UMMC is very poorly managed. Instead of just focusing on teaching, they want to spread their tentacles into all of these practices and communities to provide often mediocre, bureaucratic, cattle call health care and push out competitors. Then they (once again) pick a public fight with BCBS and cause tons of patients who now rely on them as the only game in town to have to scramble. I feel for anyone who has to interact with UMMC.

@3:43p & @4:00p- Y’all are exhausting.

First of all, self-funded/corporate/government employers DO HAVE options. Don’t be pissed at me because employers choose pretty little packages with exclusions that BCBS presents as an option. The employers like to “hide” behind these exclusions and make BCBS out to be the bad guy. Also, “co-pays” don’t even exist on all employer policies. I’ve had them with co-pays and without. A co-pay is a tiny facet of coverage. Fun fact: I remember when co-pays covered all office services and not just the visit. You won’t find that now, even though your employer has full liberty to extend that to you.

Small group “pools” are not the same as what is discussed above. These are typically DIRECTLY insured through BCBS/whatever carrier. Also, the pools would not be through both BCBS AL and BCBS MS. The coverage would be through ONE company with subscribers in states outside of the territory of that company having their claims processed through the BCBS company in the state of their medical provider. This doesn’t mean the state where the provider is located dictates coverage. The claims are processed according to the policy of the patient.

Even if you are directly insured through BCBS, there’s an array of plan options. If your employer is insuring you through a small group pool, then he/she receives a notice from BCBS every year based on the age, medical history, lifestyle history, and previous claims filed by his/her employees detailing what the upcoming premiums will be. YOUR EMPLOYER will then decide what portion he/she is willing to pay and what portion they will pass on to you. So, yes, your employer is DEFINITELY dictating your premiums. If he/she is not absorbing the extra costs of medical care for you and your co-workers 100%, be pissed at him/her, not BCBS.

Second of all, my family actually has insurance through another carrier. And just like our former employer-provider policies (some being BCBS), there are covered procedures and exclusions. Just like every other policy, the copays, deductibles, and coinsurance all vary depending on the employer. Our current policy is excellent with low copays, deductibles, and out of pocket limits because our employer can be generous due to the employee pool. The worst coverage we ever had was as a State of MS employee. This had ZERO to do with BCBS back then, and luckily I had enough sense to understand that. The coverage and costs were determined by the state. Wanna take one guess as to WHY the coverage was deplorable and costs us almost $800 a month? (Hint: it’s not because of our healthy population.

Thirdly, I can’t help it if you’re incapable of understanding how insurance policies work. The insurance industry is not a guaranteed free fall of coverage. Every single type of policy provides a detailed listing of what is covered and what is not covered. Getting emotionally hysterical over acts of God/nature that aren’t covered doesn’t make the insurance company bad. Your rantings prove you don’t know how to comprehend your policies. If you don’t like the fact that everything under the sun isn’t covered, skip the insurance and save or invest what you would spend on premiums. Then, you can bail yourself out. It’s really that simple.

Lol, I despise big pharma, so you couldn’t be more off base with your colorful insults. You’re wrong on all accounts.

I can’t believe there are commenters here that believe everyone has the same coverage and pays the same amounts for services, and that different doctors and hospitals don’t charge different amounts. Those comments alone prove you TRULY don’t understand all the dynamics at play in both the medical and insurance industries.

Is “thirdly” a word?

@7:47a- You should have opened your dictionary or Google before you typed this morning.

I'm hoping each have to pay personally out of pocket. They're all dishonest and will do or say anything for a dollar. I wouldn't take a stray dog to UMMC.