Mississippi Today

A look at what Blue Cross reimburses UMMC, both before and after the contract dispute

Published

2 years ago

June 13, 2023

Blue Cross and Blue Shield of Mississippi and the University of Mississippi Medical Center went head to head for months last year over reimbursement rates.

Turns out, it wasn’t for nothing.

An analysis by Mississippi Today and The Hilltop Institute at the University of Maryland, Baltimore County shows that in March 2022, during the throes of the dispute, Blue Cross’ negotiated rates were largely lower than other major private insurance companies — Aetna, Cigna, Humana and United — for several common procedures. This was especially true for more expensive procedures and emergency room visits.

A negotiated rate is how much an insurer has agreed to pay an in-network provider through a plan for covered services.

Hospitals perform and are reimbursed for thousands of procedures each year, but what they charge and what insurers pay has largely been kept a secret — that is, until 2021, when the federal government ordered hospitals to start publishing the data.

Mississippi Today worked with The Hilltop Institute to identify 21 common adult and pediatric procedures, then analyzed what Blue Cross reimbursed the hospital for each of those in March 2022, before the entities entered the contract dispute, and in March 2023, after the two entities renegotiated their contract.

Both Blue Cross and UMMC declined to answer any of Mississippi Today’s questions for this story.

The data show that for the selected services, Blue Cross almost never paid close to what UMMC charged, unless it was for cheaper procedures. The only exam that Blue Cross paid exactly what UMMC charged in 2022 was for a fetal non-stress test, which costs $231. (In 2023, when the cost was raised to $400, Blue Cross’ payment increased to $380.)

Hospital prices as of September 2022 show that in general, commercial negotiated rates are on average around 58% of the hospital charge for a given service, according to Morgan Henderson, principal data scientist at Hilltop.

In 2022, Blue Cross largely paid less than other private insurers for more expensive procedures, though the data shows that these insurance companies generally pay less than what UMMC charges.

According to data over the past three fiscal years from the Center for Healthcare Quality and Payment Reform, UMMC charged four times more for services provided to patients than it cost to deliver those services, which Henderson said was in line with what other hospitals charge.

Hospital charges are arbitrary — they can differ substantially from hospital to hospital. It’s rare that any payer gives hospitals the full amount they charge for any service, according to Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform.

Some key findings from 2022 data show:

Other insurers paid UMMC $250 for blood tests called total metabolic panels, $151 for comprehensive metabolic panels and $127 for therapeutic exercises. Blue Cross paid $12, $15 and $35, respectively.
With the exception of X-rays, Blue Cross paid significantly less than other private insurers did for common radiologic procedures.
Preventative care for kids and other services, such as chest radiologic exams and hospital observations, were more equitable compared to what other insurers paid — but they were all services that cost around or less than $150.
Blue Cross paid more for vaginal deliveries, C-sections and fetal tests than other companies.

Henderson pointed specifically to Blue Cross’ low reimbursement rates for emergency room visits, one of the more common reasons people visit a hospital.

For the base cost of emergency room visits (not including any other services often charged during ER visits), Blue Cross reimbursed UMMC in March 2022 at far lower rates than other major insurers and what UMMC charges — by thousands.

“In light of this, the fact that BCBS Mississippi pays only $537.38 for a level 5 ED facility fee – for which the charge is almost $4,800 – is especially striking,” Henderson said.

Emergency room visits are categorized, and charged, based on severity. For a mild injury, a patient is charged a base level 1 fee, excluding any tests that might be performed during that visit. The most severe injury constitutes a level 5 emergency room visit.

And as the severity of the emergency room visit goes up, so does the charge. Depending on the level of injury, UMMC can charge anywhere from $468 to $4,796 for an emergency room visit. But for the most severe ER trip, Blue Cross reimbursed UMMC $537, while other insurance companies paid thousands more.

“This is a very good deal for BCBS Mississippi, especially when compared to the negotiated rates that other large commercial insurers pay for this same service,” he said.

As state lawmakers continue not to expand Medicaid, health care administrators across the state report that people who are uninsured and can’t afford preventative care are using the ER more often for general health care needs.

A year later, data from March 2023 shows that payments from Blue Cross for common procedures generally remain lower than other private insurance companies. In some cases, Blue Cross still pays thousands less.

The terms of UMMC’s agreement with Blue Cross, which was decided when the dispute ended in December, have not been disclosed.

Medicare rates are typically used as a gold standard to judge whether insurer payments are too high or too low. While Blue Cross rates are reasonable compared to Medicare payments, they’re still lower than other private insurers.

“I found the (Blue Cross) vs. non-(Blue Cross) price gaps for emergency and some other procedures very large, but in general what you found is expected,” said Ge Bai, a professor of health policy and management at Johns Hopkins Carey Business School, in an email to Mississippi Today.

“Large insurers can flex their muscle on the negotiating table and make threats toward hospitals, such as what (Blue Cross) did last year. Small insurers’ threats won’t be as concerning to hospitals because their beneficiaries do not account for a large portion of the hospital’s patient volume. Therefore, small insurers’ negotiated prices can be relatively higher.”

At a market share of 55%, Blue Cross insures the majority of Mississippians with private insurance, and UMMC is the state’s largest public hospital.

But according to consumer advocates, insurers with lower negotiated rates are supposed to pass those savings on to consumers in the form of low premiums, and if a for-profit company has a big surplus, larger premiums shouldn’t be necessary.

However, that doesn’t seem to be the case for Blue Cross — at least for the past three years.

Alleging they had to pay more in claims than expected, Blue Cross raised premiums in January 2020 for small business plans and individual plans. Since then, the insurance company has raised rates for individual plans at an average of 18% and small group plans at an average of 15.6%, according to data from 2023.

After UMMC asked Blue Cross for substantially increased reimbursement rates last year and Blue Cross refused, the hospital system terminated its contract with the insurance company and subsequently went out of network in April. The move forced tens of thousands of Mississippians to pay significantly more or go elsewhere for health care, including for some services that are only available at one place in Mississippi: UMMC.

UMMC houses the state’s only Level 1 trauma center, Level IV neonatal intensive care unit and children’s hospital. It is also home to the state’s only organ transplant center, where transplant candidates with Blue Cross insurance were marked as “inactive” on the wait lists when the hospital was out of network with the insurer.

During the dispute, UMMC maintained that it was asking for below-market rates for academic medical centers, while Blue Cross officials said to increase reimbursement rates, Mississippians’ premiums would have to go up.

A Mississippi Today investigation found that Blue Cross was sitting on a huge reserve of money, to the tune of $750 million.

While insurers generally try to hold at least three times as much capital as the minimum requirement — a ratio of 300% — to ensure the company can pay out claims, Blue Cross’ ratio has been around 1,600% for years, financial records revealed. It’s significantly larger than Blue Cross peers in neighboring states, and perhaps the largest such surplus by percentage in the country.

State Insurance Commissioner Mike Chaney said it was UMMC’s goal during the dispute to get closer to a 160 to 170% reimbursement rate from Blue Cross compared to Medicare.

Chaney, who advocated on behalf of consumers during the dispute between Blue Cross and UMMC, has long complained about the difficulties in regulating insurance reimbursement rates. He has previously said that Blue Cross won’t make that data available to his office.

New health care price transparency rules, which went into effect in 2021, requires hospitals and insurers to publish their rates, but that doesn’t mean those numbers are easy to access. They’re published on an individual basis, hospital by hospital, and the files, which don’t always look the same, are huge and sometimes hard to decipher.

Gov. Tate Reeves axed a bill earlier this year that would have allowed Chaney’s office the authority to study and address inequalities in reimbursement rates among insurance companies. The bill, which Reeves called a “bad idea,” would have allowed the commissioner to fine companies thousands per violation if they can’t justify unequal reimbursement rates for different hospitals for the same procedures.

“Transparency should provide policy-makers an understanding of what is contributing to the critical financial issues hospitals, clinics, and health providers are facing,” said Mitchell Adcock, executive director of the Center for Mississippi Health Policy. “If payments are not equitable, there are no other financial sources that provide enough revenue to cover health providers' costs.”

And as state leaders continue to oppose expanding Medicaid to the working poor, providers rely on private insurance company payments to offset uncompensated care for people who are uninsured.

Uncompensated care and higher health care costs have worsened the state’s hospital crisis. A third of rural hospitals in Mississippi are at risk of closure.

“The current hospital revenue model, good or bad, is private insurance payments to help cover the limited payments from Medicare and Medicaid and help offset some of the uncompensated care cost,” Adcock said. “Therefore, private insurance payment rates have a significant impact on hospitals’ ability to operate.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Two Mississippi media companies appeal Supreme Court ruling on sealed court files

Published

18 hours ago

August 28, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-08-28 13:05:00

by Taylor Vance and Anita Lee, Sun Herald, Mississippi Today
August 28, 2025

A three-judge panel of the Mississippi Supreme Court has ruled that court records in a politically charged business dispute will remain confidential, even though courts are supposed to be open to the public.

The panel, comprised of Justice Josiah Coleman, Justice James Maxwell and Justice Robert Chamberlin, denied a request from Mississippi Today and the Sun Herald that sought to force Chancery Judge Neil Harris to unseal court records in a Jackson County Chancery Court case or conduct a hearing on unsealing the court records.

The Supreme Court panel did not address whether Harris erred by sealing court records and it has not forced the judge to comply with the court’s prior landmark decisions detailing how judges are allowed to seal court records in extraordinary circumstances.

The case in question has drawn a great deal of public interest. The lawsuit seeks to dissolve a company called Securix Mississippi LLC that used traffic cameras to ticket uninsured motorists in numerous cities in the state.

The uninsured motorist venture has since been disbanded and is the subject of two federal lawsuits, neither of which are under seal. In one federal case, an attorney said the chancery court file was sealed to protect the political reputations of the people involved.

Quinton Dickerson and Josh Gregory, two of the leaders of QJR, are the owners of Frontier Strategies. Frontier is a consulting firm that has advised numerous elected officials, including four sitting Supreme Court justices. The three justices who considered the media’s motion for relief were not clients of Frontier.

The two news outlets on Thursday filed a motion asking the Supreme Court for a rehearing.

Courts are open to public

In their motion for a rehearing, the media companies are asking that the Supreme Court send the case back to chancery court, where Harris should be required to give notice and hold a hearing to discuss unsealing the remaining court files.

Courts and court files are supposed to be open and accessible to the public. The Supreme Court has, since 1990, followed a ruling that lays out a procedure judges are supposed to follow before closing any part of a court file. The judge is supposed to give 24 hours notice, then hold a hearing that gives the public, including the media, an opportunity to object.

At the hearing, the judge must consider alternatives to closure and state any reasons for sealing records.

Instead, Harris closed the court record without explanation the same day the case was filed in September 2024. In June, Harris denied a motion from Mississippi Today to unseal the file.

The case, he wrote in his order, is between two private companies. “There are no public entities included as parties,” he wrote, “and there are no public funds at issue. Other than curiosity regarding issues between private parties, there is no public interest involved.”

Harris

But that is at least partially incorrect. The case involves Securix Mississippi working with city police departments to ticket uninsured motorists. The Mississippi Department of Public Safety had signed off on the program and was supposed to be receiving a share of the revenue.

Mississippi Today and the Sun Herald then filed for relief with the state Supreme Court, arguing that Harris improperly closed the court file without notice and did not conduct a hearing to consider alternatives.

After the media outlets’ appeal to the Supreme Court, Harris ordered some of the records in the case to be unsealed.

But he left an unknown number of exhibits under seal, saying they contain “financial information” and are being held in a folder in the Chancery Clerk’s Office.

File improperly sealed, media argues

The three-judge Supreme Court panel determined the media appeal was no longer relevant because Harris had partially unsealed the court file.

In the news outlets’ appeal for rehearing, they argue that if the Supreme Court does not grant the motion, the state’s highest court would virtually give the press and public no recourse to push back on judges when they question whether court records were improperly sealed.

“The original … sealing of the entire file violated several rights of the public and press … which if not overruled will be capable of repetition yet, evading review,” the motion reads.

The media companies also argue that Harris’ order partially unsealing the chancery court case was not part of the record on appeal and should not have been considered by the Supreme Court. His order to partially unseal the case came 10 days after Mississippi Today and the Sun Herald filed their appeal to the Supreme Court.

Charlie Mitchell, a lawyer and former newspaper editor who has taught media law at the University of Mississippi for years, called Judge Harris’ initial order keeping the case sealed “illogical.” He said the judge’s second order partially unsealing the case appears “much closer” to meeting the court’s standard for keeping records sealed, but the judge could still be more specific and transparent in his orders.

Instead of simply labeling the sealed records as “financial information,” Mitchell said the Supreme Court could promote transparency in the judiciary by ordering Harris to conduct a hearing — something he should have done from the outset — or redact portions of the exhibits.

“Closing a record or court matter as the preference of the parties is never — repeat never — appropriate,” Mitchell said. “It sounds harsh, but if parties don’t want the public to know about their disputes, they should resolve their differences, as most do, without filing anything in a state or federal court.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Two Mississippi media companies appeal Supreme Court ruling on sealed court files appeared first on mississippitoday.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The content focuses on transparency, accountability, and the public’s right to access court records, which aligns with values often emphasized by center-left perspectives. It critiques the sealing of court documents and advocates for media and public oversight of judicial processes, reflecting a concern for government openness and checks on power. However, the article maintains a factual tone without overt political partisanship, situating it slightly left of center due to its emphasis on transparency and media rights.

Mississippi Today

Judge: Felony disenfranchisement a factor in ruling on Mississippi Supreme Court districts

Published

2 days ago

August 27, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-08-27 05:00:00

by Taylor Vance, Mississippi Today
August 27, 2025

The large number of Mississippians with voting rights stripped for life because they committed a disenfranchising felony was a significant factor in a federal judge determining that current state Supreme Court districts dilute Black voting strength.

U.S. District Judge Sharion Aycock, who was appointed to the federal bench by George W. Bush, last week ruled that Mississippi’s Supreme Court districts violate the federal Voting Rights Act and that the state cannot use the same maps in future elections.

Mississippi law establishes three Supreme Court districts, commonly referred to as the northern, central and southern districts. Voters elect three judges from each to the nine-member court. These districts have not been redrawn since 1987.

The main district at issue in the case is the central district, which comprises many parts of the majority-Black Delta and the majority-Black Jackson Metro Area.

Several civil rights legal organizations filed a lawsuit on behalf of Black citizens, candidates, and elected officials, arguing that the central district does not provide Black voters with a realistic chance to elect a candidate of their choice.

The state defended the districts arguing the map allows a fair chance for Black candidates. Aycock sided with the plaintiffs and is allowing the Legislature to redraw the districts.

The attorney general’s office could appeal the ruling to the U.S. 5th Circuit Court of Appeals. A spokesperson for the office stated that the office is reviewing Aycock’s decision, but did not confirm whether the office plans to appeal.

In her ruling, Aycock cited the testimony of William Cooper, the plaintiff’s demographic and redistricting expert, who estimated that 56,000 felons were unable to vote statewide based on a review of court records from 1994 to 2017. He estimated 60% of those were determined to be Black Mississippians.

Cooper testified that the high number of people who were disenfranchised contributed to the Black voting age population falling below 50% in the central district.

Attorneys from Attorney General Lynn Fitch’s office defended the state. They disputed Cooper’s calculations, but Aycock rejected their arguments.

The AG’s office also said Aycock should not put much weight on the number of disenfranchised people because the U.S. Fifth Circuit Court of Appeals previously ruled that Mississippi’s disenfranchisement system doesn’t violate the Equal Protection Clause of the 14th Amendment.

Aycock, however, distinguished between the appellate court’s ruling that the system did not have racial discriminatory intent and the current issue of the practice having a racially discriminatory impact.

“Notably, though, that decision addressed only whether there was discriminatory intent as required to prove an Equal Protection claim,” Aycock wrote. “The Fifth Circuit did not conclude that Mississippi’s felon disenfranchisement laws have no racially disparate impact.”

Mississippi has one of the harshest disenfranchisement systems in the nation and a convoluted method for restoring voting rights to people.

Other than receiving a pardon from the governor, the only way for someone to regain their voting rights is if two-thirds of legislators from both chambers at the Capitol, the highest threshold in the Legislature, agree to restore their suffrage.

Lawmakers only consider about a dozen or so suffrage restoration bills during the session, and they’re typically among the last items lawmakers take up before they adjourn for the year.

Under the Mississippi Constitution, people convicted of a list of 10 types of felonies lose their voting rights for life. Opinions from the Mississippi Attorney General’s Office have since expanded the list of specific disenfranchising felonies to 23.

The practice of stripping voting rights away from people for life is a holdover from the Jim Crow era. The framers of the 1890 Mississippi Constitution believed Black people were most likely to commit certain crimes.

Leaders in the state House have attempted to overhaul the system, but none have gained any significant traction in both chambers at the Capitol.

Last year, House Constitution Chairman Price Wallace, a Republican from Mendenhall, advocated a constitutional amendment that would have removed nonviolent offenses from the list of disenfranchising felonies, but he never brought it up for a vote in the House.

Wallace and House Elections Chairman Noah Sanford, a Republican from Collins, are leading a study committee on Sept. 11 to explore reforms to the felony suffrage system and other voting legislation.

Wallace previously said on an episode of Mississippi Today’s “The Other Side” podcast that he believes the state should tackle the issue because one of his core values, part of his upbringing, is giving people a second chance, especially once they’ve made up for a mistake.

“This issue is not a Republican or Democratic issue,” Wallace said. “It allows a woman or a man, whatever the case may be, the opportunity to have their voice heard in their local elections. Like I said, they’re out there working. They’re paying taxes just like you and me. And yet they can’t have a decision in who represents them in their local government.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Judge: Felony disenfranchisement a factor in ruling on Mississippi Supreme Court districts appeared first on mississippitoday.org

Political Bias Rating: Center-Left

This article presents a focus on voting rights and racial justice issues, highlighting the impact of felony disenfranchisement on Black voters in Mississippi. It emphasizes civil rights concerns and critiques longstanding policies rooted in the Jim Crow era, which aligns with center-left perspectives advocating for expanded voting access and systemic reform. The coverage is factual and includes viewpoints from multiple sides, but the framing and emphasis on racial disparities and voting rights restoration suggest a center-left leaning.

Mississippi Today

Jackson police chief steps down to take another job, national search to come

Published

3 days ago

August 26, 2025

Staff Editor

mississippitoday.org – @mintamolly – 2025-08-26 12:39:00

by Molly Minta, Mississippi Today
August 26, 2025

Jackson Police Department Chief Joseph Wade told the mayor last week he was choosing to retire after 29 years of service and two years at the helm of the force. Wade said he’d been given another job opportunity, which has yet to be announced.

His last day is Sept. 5.

Mayor John Horhn said he told Wade the officer would be crazy not to take the job — one that comes with less stress and more pay.

“His wife has been on his back, his blood pressure has been up,” Horhn said during Tuesday’s City Council meeting. “He has done a commendable job.”

Wade became chief during a period in which Jackson was called the murder capital of America. Under his tenure, Wade said crime has fallen markedly, including a roughly 45% reduction in homicides so far this year compared to the same period in 2024, the Clarion Ledger reported. He said he’s also increased JPD’s force by 37, for a total of 258 officers.

Wade said his biggest accomplishment is reestablishing trust. “We are no longer the laughing stock of the law enforcement community,” he said.

The chief’s departure comes less than two months after Horhn took office, replacing former Mayor Chokwe Antar Lumumba who originally appointed Wade, and on the heels of a spate of shootings that Wade said were driven by gangs of young men.

“I have received so many calls from the community: ‘Chief, please don’t leave us,'” Wade told the crowd in council chambers.

But Wade said he “would rather leave prematurely than overstay my welcome,” adding that the average tenure of a police chief is 2.5 years.

Wade said that last year he stood next to Jackson Councilman Kenny Stokes and told the media he was going to cut crime in half, “And what did I do? Cut it in half,” he said.

“What I’ve seen in our community in some situations is people want police, but they don’t want to be policed,” Wade said.

Hinds County Sheriff Tyree Jones will serve as interim police chief until the administration finds a replacement. Jones said he has not finalized a contract with the city, responding to a question about whether he will draw a salary from both agencies.

“I could think of no one better than the sheriff of Hinds County,” Horhn said, adding that the appointment is temporary.

Jones said during the meeting that his responsibility as sheriff will continue uninterrupted and that his goal within JPD is to ensure continued professionalism in the department.

“I extend my heartfelt gratitude to my dear friend and retired police chief Joe Wade,” Jones said. “Again, let me be clear, I have no aspirations to permanently hold the position.”

Horhn said there is precedence for the dual role that “Chief Sheriff Jones is about to embark upon,” citing former mayor Frank Melton’s hiring of Sheriff Malcolm McMillin.

The city has enlisted help from former U.S. Marshal George White and the former chief of the Mississippi Highway Patrol, Col. Charles Haynes, to lead the Law Enforcement Task Force that will conduct a nationwide search to fill the position. The administration expects that to take between 30 and 60 days, according to a city press release.

The release said the task force will also examine safety challenges in Jackson more broadly, such as youth crime, drug crimes, departmental needs and interagency coordination.

“I am grateful that Marshal White and Col. Haynes have agreed to lead this important effort. Their breadth of experience, commitment to public safety and deep understanding of law enforcement challenges will ensure the task force conducts a rigorous search for our next chief,” said Horhn. “I am confident they will help shape solutions that address the evolving needs of Jackson.”

The city said it would soon release details about the opportunity for the public to offer input on the process.

“Hinds County is all in for whatever we have to do to make Jackson and Hinds County the safest it can be,” Hinds County Supervisors President Robert Graham said during the meeting.

Wade, who hails from nearby Terry, graduated from JPD’s 23rd recruit class in 1995, rising from a police recruit and hitting every rung of the ladder on his way to chief. “I was homegrown,” he said.

Wade said he received “an amazing offer in a private sector at an amazing organization. Don’t ask me where. That will be released at the appropriate time.”

This story may be updated.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Jackson police chief steps down to take another job, national search to come appeared first on mississippitoday.org

Political Bias Rating: Centrist

The article presents a straightforward news report on the resignation of a police chief, focusing on facts, quotes from officials, and crime statistics without evident ideological framing. It covers perspectives from multiple local government figures and avoids partisan language, reflecting a neutral, balanced tone typical of centrist reporting.