Blue Cross: Dispute forces man in need of transplant toward Texas

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This Mississippian needs a new liver. The state’s only transplant hospital can’t give it to him.

Blue Cross: Dispute Forces Man In Need Of Transplant Toward Texas
Caden LeMieux smiles on the day he was discharged from UMMC. He left for Houston the next day.

Caden LeMieux is lying in a bed at Hermann Memorial Hospital in Houston, Texas, more than 500 miles away from his home, his mother and the majority of his friends and family in Neshoba County. 

He’s 450 miles from the doctors and nurses at the he’s been seeing for more than a year for primary sclerosing cholangitis, a serious and long-term liver disease that has been treated at Mississippi’s only organ transplant center. 

The 28-year-old was admitted to UMMC July 7 following excruciating stomach pain and high levels of bilirubin, which caused his skin and eyes to turn yellow. LeMieux, who is 6’2, usually weighs somewhere in the 130-pound range, but weight kept coming off.

He was told he was in active liver failure and needed a transplant imminently. But UMMC couldn’t do it, his doctor said. The reason: the hospital’s ongoing contract dispute with Blue Cross & Blue Shield of Mississippi, which left the state’s largest hospital out of network with its largest private insurer since April 1. 

While the two parties are currently in mediation, there is no resolution in sight.

“They (the UMMC doctors and nurses) tried their best to find a loophole around it … the best they could,” said LeMieux, who has Blue Cross through his stepmother’s Texas plan. “They couldn’t come up with anything.”

LeMieux’s mother Cristi Montgomery described the difficulty of that moment. 

“I tell you, they were teary-eyed because they knew it wasn’t fair,” Montgomery said of the doctors and nurses who’d been taking care of LeMieux at UMMC. 

Blue Cross: Dispute Forces Man In Need Of Transplant Toward Texas
Caden LeMieux at his youngest brother’s graduation in May 2022.

“I really didn’t want to leave (UMMC),” LeMieux said on Monday, a day after undergoing a procedure to drain fluid from his lungs to allow him to breathe more easily. “It’s been a lot of nights I’ve gotten overwhelmed.”

Neither UMMC nor Blue Cross responded to requests for comment for this story by the time of publication. 

Montgomery said the dispute between UMMC and Blue Cross has forced her son out of his comfort zone in a trying time.

“You’re having to meet people that you’re not comfortable with, establish new relationships — we ain’t got time for that. We’re sick enough, don’t take us out of our comfort zone,” said Montgomery. 

UMMC and Blue Cross are butting heads over reimbursement rates and the insurance company’s quality care plan. UMMC, the state’s only academic medical center and safety net hospital, is asking Blue Cross for substantial increases in its reimbursement rates. Blue Cross officials say this is unreasonable and would necessitate an increase in members’ premiums.

Mississippi Insurance Commissioner Mike Chaney has issued calls for the two parties to come to an agreement to no avail. He recently informed Blue Cross his department will be conducting a target market conduct examination of the insurer to determine whether it is compliant with the state’s network adequacy regulations, which require insurers to provide adequate in-network care to customers.  

LeMieux made the nine-hour drive to Houston just over a week ago. His mother drove him from Jackson to Baton Rouge, where his father, who lives in Houston, met them. He finished out the ride with his dad and was back in the hospital the next day.

LeMieux was fortunately still considered an active patient at Hermann Memorial Hospital after living there with his father several years ago. His family thought he would only be in the Houston hospital temporarily and then return to his father’s house to wait for a liver to become available. Doctors have since decided he’s too sick to leave, and he will have to stay in the hospital until his transplant. 

Until then, he and his loved ones play a waiting game. He will have to spend an additional 10 days in the hospital after receiving the transplant — assuming there are no complications — and then will have to remain in the Houston area for at least a year. His transplant follow-up care will include twice-weekly clinic visits with the goal of eventually reducing the frequency. 

But LeMieux, Montgomery, and Colville LeMieux, Caden’s father, aren’t looking that far ahead yet. They’re focused on the immediate situation. They feel lucky to have the support and prayers of their community, Montgomery said. 

But they can’t help but wonder.

“I asked the hospital, ‘What if his daddy hadn’t lived there? We would have to go live in Houston or go to UAB or Ochsner’s?’ Of course you want to do what’s best for your kids, but let’s be real, we own our own businesses, we don’t have any vacation time, we can’t just take off,” said Montgomery, who runs a bakery in Philadelphia with her husband. 

Colville LeMieux, Caden’s father, had a similar take: “I don’t know what we would’ve done if we hadn’t had him under care here at a Houston doctor also. What is a person supposed to do?”

On Monday, Montgomery started the drive to Houston. She doesn’t know how long she’ll be there or how her bakery in Neshoba County will stay afloat in the coming weeks and months. But she does know she needs to be with her son.

“It’s easy to say, ‘Either you trust God or you don’t,’ but that’s all we have is to trust and believe and take it one day at a time. When Caden’s nine hours away and he sends you a message that says, ‘I’m scared,’ and then calls and he’s crying …” she trailed off. 

“It’s just a lot. But you still do what you have to do.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.Blue Cross: Dispute Forces Man In Need Of Transplant Toward TexasBlue Cross: Dispute Forces Man In Need Of Transplant Toward Texas