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

Jackson’s performing arts venue Thalia Mara Hall is now open

Published

19 hours ago

June 30, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-06-30 17:29:00

by Maya Miller, Mississippi Today
June 30, 2025

After more than 10 months closed due to mold, asbestos and issues with the air conditioning system, Thalia Mara Hall has officially reopened.

Outgoing Mayor Chokwe A. Lumumba announced the reopening of Thalia Mara Hall during his final press conference held Monday on the arts venue’s steps.

“Today marks what we view as a full circle moment, rejoicing in the iconic space where community has come together for decades in the city of Jackson,” Lumumba said. “Thalia Mara has always been more than a venue. It has been a gathering place for people in the city of Jackson. From its first class ballet performances to gospel concerts, Thalia Mara Hall has been the backdrop for our city’s rich cultural history.”

Thalia Mara Hall closed last August after mold was found in parts of the building. The issues compounded from there, with malfunctioning HVAC systems and asbestos remediation. On June 6, the Mississippi State Fire Marshal’s Office announced that Thalia Mara Hall had finally passed inspection.

“We’re not only excited to have overcome many of the challenges that led to it being shuttered for a period of time,” Lumumba said. “We are hopeful for the future of this auditorium, that it may be able to provide a more up-to-date experience for residents, inviting shows that people are able to see across the world, bringing them here to Jackson. So this is an investment in the future.”

In total, Emad Al-Turk, a city contracted engineer and owner of Al-Turk Planning, estimates that $5 million in city and state funds went into bringing Thalia Mara Hall up to code.

The venue still has work to be completed, including reinstalling the fire curtain. The beam in which the fire curtain will be anchored has asbestos in it, so it will have to be remediated. In addition, a second air-conditioning chiller needs to be installed to properly cool the building. Until it’s installed, which could take months, Thalia Mara Hall will be operating at a lower seating capacity of about 800.

“Primarily because of the heat,” Al-Turk said. “The air conditioning would not be sufficient to actually accommodate the 2,000 people at full capacity, but starting in the fall, that should not be a problem.”

Al-Turk said the calendar is open for the city to begin booking events, though none have been scheduled for July.

“We’re very proud,” he said. “This took a little bit longer than what we anticipated, but we had probably seven or eight different contractors we had to coordinate with and all of them did a superb job to get us where we are today.”

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

The post Jackson’s performing arts venue Thalia Mara Hall is now open 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: Centrist

The article presents a straightforward report on the reopening of Thalia Mara Hall in Jackson, focusing on facts and statements from city officials without promoting any ideological viewpoint. The tone is neutral and positive, emphasizing the community and cultural significance of the venue while detailing the challenges overcome during renovations. The coverage centers on public investment and future prospects, without partisan framing or editorializing. While quotes from Mayor Lumumba and a city engineer highlight optimism and civic pride, the article maintains balanced, factual reporting rather than advancing a political agenda.

Mississippi Today

‘Hurdles waiting in the shadows’: Lumumba reflects on challenges and triumphs on final day as Jackson mayor

Published

24 hours ago

June 30, 2025

Staff Editor

mississippitoday.org – @ayewolfe – 2025-06-30 17:08:00

by Anna Wolfe and Molly Minta, Mississippi Today
June 30, 2025

On his last day as mayor of Jackson, Chokwe Antar Lumumba recounted accomplishments, praised his executive team and said he has no plans to seek office again.

He spoke during a press conference outside of the city’s Thalia Mara Hall, which was recently cleared for reopening after nearly a year of remediation. The briefing, meant to give media members a peek inside the downtown theater, marked one of Lumumba’s final forays as mayor.

Longtime state Sen. John Horhn — who defeated Lumumba in the Democratic primary runoff — will be inaugurated as mayor Tuesday, but Lumumba won’t be present. Not for any contentious reason, the 42-year-old mayor noted, but because he returns to his private law practice Tuesday.

“I’ve got to work now, y’all,” Lumumba said. “I’ve got a job.”

Thalia Mara Hall’s presumptive comeback was a fitting end for Lumumba, who pledged to make Jackson the most radical city in America but instead spent much of his eight years in office parrying one emergency after another. The auditorium was built in 1968 and closed nearly 11 months ago after workers found mold caused by a faulty HVAC system – on top of broken elevators, fire safety concerns and vandalism.

“This job is a fast-pitched sport,” Lumumba said. “There’s an abundance of challenges that have to be addressed, and it seems like the moment that you’ve gotten over one hurdle, there’s another one that is waiting in the shadows.”

Outside the theater Monday, Lumumba reflected on the high points of his leadership instead of the many crises — some seemingly self-inflicted — he faced as mayor.

He presided over the city during the coronavirus pandemic and the rise in crime it brought, but also the one-two punch of the 2021 and 2022 water crises, exacerbated by the city’s mismanagement of its water plants, and the 18-day pause in trash pickup spurred by Lumumba’s contentious negotiations with the city council in 2023.

Then in 2024, Lumumba was indicted alongside other city and county officials in a sweeping federal corruption probe targeting the proposed development of a hotel across from the city’s convention center, a project that has remained stalled in a 20-year saga of failed bids and political consternation.

Slated for trial next year, Lumumba has repeatedly maintained his innocence.

The city’s youngest mayor also brought some victories to Jackson, particularly in his first year in office. In 2017, he ended a furlough of city employees and worked with then-Gov. Phil Bryant to avoid a state takeover of Jackson Public Schools. In 2019, the city successfully sued German engineering firm Siemens and its local contractors for $89 million over botched work installing the city’s water-sewer billing infrastructure.

“I think that that was a pivotal moment to say that this city is going to hold people responsible for the work that they do,” Lumumba said.

Lumumba had more time than any other mayor to usher in the 1% sales tax, which residents approved in 2014 to fund infrastructure improvements.

“We paved 144 streets,” he said. “There are residents that still are waiting on their roads to be repaved. And you don’t really feel it until it’s your street that gets repaved, but that is a significant undertaking.”

And under his administration, crime has fallen dramatically recently, with homicides cut by a third and shootings cut in half in the last year.

Lumumba was first elected in 2017 after defeating Tony Yarber, a business-friendly mayor who faced his own scandals as mayor. A criminal justice attorney, Lumumba said he never planned to seek office until the stunning death of his father, Chokwe Lumumba Sr., eight months into his first term as mayor in 2014.

“I can say without reservation, and unequivocally, we remember where we started. We are in a much better position than we started,” Lumumba said.

Lumumba said he has sat down with Horhn in recent months, answered questions “as extensively as I could,” and promised to remain reachable to the new mayor.

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

The post 'Hurdles waiting in the shadows': Lumumba reflects on challenges and triumphs on final day as Jackson mayor appeared first on mississippitoday.org

Political Bias Rating: Center-Left

The article reports on outgoing Jackson Mayor Chokwe Antar Lumumba’s reflections without overt editorializing but subtly frames his tenure within progressive contexts, emphasizing his self-described goal to make Jackson “the most radical city in America.” The piece highlights his accomplishments alongside challenges, including public crises and a federal indictment, maintaining a factual tone yet noting contentious moments like labor disputes and governance issues. While it avoids partisan rhetoric, the focus on social justice efforts, infrastructure investment, and crime reduction, as well as positive framing of Lumumba’s achievements, aligns with a center-left perspective that values progressive governance and accountability.

Mississippi Today

Feds unfreeze $137 million in Mississippi education money

Published

1 day ago

June 30, 2025

Staff Editor

mississippitoday.org – @devnabose – 2025-06-30 15:37:00

by Devna Bose, Mississippi Today
June 30, 2025

The federal government is restoring $137 million in education funds to Mississippi schools.

The U.S. Department of Education notified states last week that it would reinstate pandemic relief funds. The decision comes less than three months after the federal government revoked billions nationwide as part of Trump administration efforts to cut government spending.

State education agencies and school districts originally had until March 2026 to spend the money, but the federal government claimed that because the pandemic was over, they had no use for the money.

That March 2026 deadline has been reinstated following a series of injunctive orders.

A coalition of Democratic-led states sued the federal government in April over the decision to withhold the money. Then, a federal judge granted plaintiff states injunctive orders in the case, which meant those states could continue spending their COVID-relief dollars while other states remained restricted.

But the education department decided that wasn’t fair, wrote Secretary Linda McMahon in a letter dated June 26, so the agency was restoring the money to all states, not just the ones involved in the lawsuit.

“The original intent of the policy announced on March 28 was to treat all states consistently with regards to safeguarding and refocusing their remaining COVID-era grant funding on students,” she wrote. “The ongoing litigation has created basic fairness and uniformity problems.”

The Mississippi Department of Education notified school districts about the decision on Friday.

In the meantime, schools and states have been requesting exemptions for individual projects, though many from across the country have been denied.

Eleven Mississippi school districts had submitted requests to use the money to fund services such as tutoring and counseling, according to records requested by Mississippi Today, though those are now void because of the federal government’s decision.

Starting immediately, school districts can submit new requests to the state education department to draw down their federal allocation.

Mississippi Today previously reported that about 70 school districts were relying on the federal funds to pay for a range of initiatives, including construction projects, mental health services and literacy programs.

In 2023, almost half of Elementary and Secondary School Emergency Relief funds, pandemic relief money allocated to schools across the country, went to students’ academic, social, and emotional needs. A third went to operational and staff costs, according to a report from the U.S. Department of Education.

Though Lt. Gov. Delbert Hosemann previously said that legislative leaders might consider helping agencies that were impacted by federal funding cuts, House Speaker Jason White said Monday that he did not have an appetite for directing state funds to pandemic-era programs.

Small school districts were already feeling the impact of the federal government’s decision to rescind the money. In May, Greenwood Leflore Consolidated School Board voted to terminate a contract on a school construction project funded with federal dollars.

The litigation is ongoing, so the funding could again be rescinded.

Clarification: A previous version of this article misstated the status of school districts’ pandemic relief money.

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

The post Feds unfreeze $137 million in Mississippi education money appeared first on mississippitoday.org

Political Bias Rating: Centrist

This article primarily reports on the federal government’s decision to restore $137 million in education funds to Mississippi schools after a temporary freeze. It presents factual information about the timeline, legal actions, and responses from various state officials without adopting a partisan tone. The piece mentions the involvement of Democratic-led states suing the federal government and notes Republican-aligned efforts to cut spending, but does so in a balanced way focused on reporting events and statements rather than promoting a political viewpoint. The language remains neutral and factual, avoiding loaded or biased framing, making it a straightforward news report with centrist bias.