In an October 18 letter, Insurance Commissioner Mike Chaney told Governor Phil Bryant he could not force Blue Cross and HMA to enter into a contract. The Governor asked him to do so and said he will order Blue Cross to reinstate all HMA hospitals to network status if the Commissioner does not take such action.
Mr. Chaney stated:
"I am deeply troubled by the HMA and BCBS network dispute and am especially concerned about the medical practitioners, hospital employees, and patients who are caught squarely in the middle. I have repeatedly reached out to both HMA and BCBS and asked them to meet face to face in an effort to resolve their differences. Speaking candidly and with all due respect to the parties involved, the fact that a lawsuit was filed has impacted my ability to help facilitate a resolution by bringing the parties to the table. Issues germane to the provider contracts between HMA and BCBS are now subject to the jurisdiction of the court.
Despite the pending litigation in this matter, I agree that regulatory enforcement action is appropriate, as long as that enforcement action is supported by applicable law with sufficient evidence....
Oue examiners are in the process of reviewing geographic access to ensure that BCBS members will have to travel no more than sixty minutes or sixty miles for primary care in rural regions and thirty minutes or thirty miles for primary care in urban regions.... The examiners are looking at the capacity of the remaining network hospitals in view of the number of BCBS policyholders in a particular service area....
The Department has reviewed the eight named practices that would be considered unfair trade practices under Section 93-5-55 adn at this time, we have not uncovered any act or practice on the part of BCBS in its dealings with HMA that would constitute an unfair trade practice....
We have serious concerns, however, whether ordering BCBS to reinstate the hospitals is a remedy supported by and available under the Unfair trade practices Act. Again, unfair trade practices are remedied through cease and desist orders and fines.
It was my understanding from our conversation yesterday that you would be invoking your executive authority under the public health law to require BCBS to re-contract with or reinstate the ten hospitals. As I indicated in that conversation, I would be fully supportive of that effort and would gladly yield to any general executive authority you may have as Governor. I would be concerned, however, about the legal viability of ordering the parties to re-contract on the ground that BCBS has violated the Unfair Trade Practices Act. Such a remedy simply does not appear sustainable under that Act. (p.6).
So it appears the Commissioner is telling the Governor his threatened executive order is illegal if he indeed issues one. This is getting more and more interesting
21 comments:
More original fully sourced reporting!
Good Lord Kingfish what are they going to do in Fondren now? Highlight yet another AP story about Chris Christie and gay marriage?
Gotta run. I'm on deadline.
We"ll see if $500,000 is enough to force Bryant to do something unlawful
Why not build infrastructure for United Healthcare and Humana on the governments dime and destroy Blue Cross Blue Shield's monopoly?
United is actually greedier than BCBS. Don't know anything about Humana.
2:02,
Now you're talking! Gotta be cheaper than the inevitable lawsuit by BCBS thanks to Gov Feel.
At least with your idea more folks would benefit.
Phil has borrowed a play from the Obama playbook with this threat. Who cares what the LAW is, by God, I can issue executive ORDERS!!! All these polititians are nothing but excrement...
I suppose Phil supercedes the legal system, federal law and common sense. Long live King Phil.
Really sick and tired of Blue Cross on their high horse, with awful customer service and treating the employees like crap.
4:13
We have never heard such a thing!
Bryant is confused "Again"!! He does not understand what he was elected to do!! BCBS/HMA are not state agencies!! When he was elected, I compared him to Cliff Finch - I take it back, he is worse than Finch!! But, that's what you get when you elect a "Redneck" as governor of your state!
This is like bitching that we don't like Ford trucks. Bryant can no more regulate free enterprise than he can require Ford to install sprayed bedliners on all trucks for sale. The biggest goober since Cliff Finch.
6:13 & 7:36
Your Blue is showing
9:15 This is 6:13. I can't speak for 7:36. I can speak only for myself, as one who always votes a Republican ticket. However, I just cannot vote for "Rednecks" who refer to themselves as Republicans.
It appears we are getting down to the real issue in health care - money.
HMA is one of the largest "for profit" hospital chains in the USA. (Profits distributed to share holders).
BCBS is a mutual insurance company (profits are returned to policy holders by reduced premiums).
HMA is currently in a fiscal mess (board of directors recently replaced, all officers gone) and is seeking to increase it's bottom line by upping charges (how HMA and other private hospitals determine what to charge is a science in itself...one I do not understand).
BCBS said no to increases in prices. Something individuals could never do.
So the little guy (individual) is having to seek protection from a monopoly health insurance company.
You can see who is gonna get screwed here without much more effort.
Phil has no authority to order parties to contract.
But - the legislature will surely be called upon to address the problem. And no they will not advocate removing barriers to out of state insurers...they will seek more penal routes with burdensome regulations (which will be clouded by HMA placed legislators)...
In short , eat less, exercise more, and check out foreign countries for medical care....ours is about to be screwed up for decades to come.
"BCBS said no to increases in prices. Something individuals could never do. "
Wrong.
BCBS reduced their payments for previously agreed-upon prices. Big difference. They unilaterally stopped honoring the contract they signed. Future price increases are a theoretical problem in the future.
This is for 7.30. Blue cross has not lowered premiums in years, despite record profits.
"BCBS reduced their payments for previously agreed-upon prices."
As I understand it from reading the complaint, HMA and BCBS have not had a contract since 2011, and the 2011 rates were being used up until the lawsuit was filed by HMA in 2013. Was BCBS paying less than the 2011 rates prior to the lawsuit? I've seen posts both going both ways on this point.
Most people don't realize what all the fuss is about. HMA overcharges for their services period. I know of an elderly couple who went in for knee replacement. Husband and Wife. One to St d's one to river oaks. St D's bill 40k
River Oaks 140k
They (HMA) are bilking the system. I am no fan of Blue Cross but just start adding up the difference in just one surgery and Blue Cross had to do something. Big Phil shouldn't be involved at all...
Don't really have a dog in this fight either way since I don't have Blue Cross or use any of the hospitals in this mess. But, I do know my grandbaby had a procedure at River Oaks and they sure pressured the kids to sign their petition and send an email against Blue Cross, even though they have United policy. Also, can't help but notice how much the hospital is shelling out on TV, radio, newpaper, internet ads (even on this blog now), websites, telephone calling, mailings and now the billboards all over Jackson metro. I retired from media business and trust me, most of those media buys ain't cheap.
2:14 Several points about your post seem extraordinarily unlikely or irrelevant.
1) The word "elderly" translates as "using Medicare" - not BC/BS. Assuming there was no difference in the procedures (e.g. - did one of the couple suffer an MI on the table and spend two weeks in the ICU?), it doesn't matter what the charges were from each hospital - Medicare paid them each the same, and I'm sure they paid less than any private insurer you can name.
2) If one half of a couple had a great experience and outcome from his or her knee replacement surgery, why on earth would the other spouse go to a different hospital with a different surgeon? Could it be they were extremely unhappy with the experience at the less expensive hospital? In 25 years of practice I've never known a family to have two different orthopods for the same type of procedure.
3) A minor point - Baptist is the place to go round here for knee replacements. ROH and St. Ds do some wonderful stuff, but we're talking knee replacements here.
This is for 11:47,who corrected 7:30.BCBS lost money last year.HMA hospitals in metro area made over $100 million in profits.Get your facts straight
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