Blue Cross, UMMC agree to mediation to settle contract dispute

by Kate Royals, Mississippi Today
April 27, 2022

out of network with its largest insurer.

The decision comes after Mississippi Insurance Commissioner Mike Chaney sent them a letter on April 21 urging them to agree to mediation. The arbitration process involves bringing in an expert and impartial mediator who can preside over new contract negotiations. 

Chaney told Mississippi Today on Thursday that he'll be providing several recommendations for prospective mediators by next week. 

Blue Cross and UMMC used the same mediation process to settle their last contract dispute in 2018, and it took around ten days to strike a deal, Chaney said. At that time, Blue Cross agreed to remove language that made the contract evergreen, meaning the insurance company could no longer change the contract terms at any time.

UMMC claims that between 2014 and 2017, Blue Cross made annual changes to their reimbursement rates that decreased the overall reimbursement UMMC received to care for Blue Cross patients.·UMMC received an overall 1% increase as part of the 2018 negotiations, but no changes have been made to their reimbursement rates since then.

After the two parties agree on who the mediator should be, a deadline will be set for them to settle their differences.  Chaney told Mississippi Today that the deadline will likely be  June 1 – 30 days before the end of the 90-day “continuity of care” period, where certain Blue Cross patients can still receive care at UMMC and have their insurance accepted. 

Under state agency rules, Chaney is not allowed to directly mediate or help settle disputes over contacts between insurance companies and health care providers.

Chaney's involvement stems from concerns that UMMC not being in Blue Cross' network runs afoul of state network adequacy regulations due to UMMC providing services that cannot be found elsewhere in the state, such as its organ transplant unit and children's hospital.

BCBSMS maintains that even without UMMC, it is still meeting its network adequacy requirement. BCBSMS also said that the remedy in a situation where network adequacy is an issue is for it to provide network level benefits to its customers for those services, which it has offered to do by directing its members to sign a written direction of payment instructing the insurer to pay the hospital. 

UMMC has declined to accept those payments from BCBS, arguing that it would allow BCBSMS to continue paying at unsustainable rates. 

UMMC and Blue Cross have not been in communication since April 1, when UMMC officially went out of network with the insurance company, according to officials from both entities. Tens of thousands of Mississippians – some of them gravely ill and others in need of advanced specialties only available at UMMC – are stuck in the middle of the dispute.

Though the two parties have had similar contract disputes in previous years, this is the first time UMMC has been removed from BCBSMS' network. 

As a result, tens of thousands of Mississippians have been left to face higher out-of-pocket medical expenses or find care elsewhere. Potential transplant recipients who have spent months or years on organ donation waitlists have been placed on hold. Parents of children who require specialized care that can only be provided at UMMC's children's hospital have been left with costly and inconvenient options for continuing their child's care. 

UMMC is asking Blue Cross for substantial increases to inpatient, outpatient and professional reimbursement rates, some as large as 50%. Overall reimbursement from Blue Cross would increase by around 30% in the first year of the new contract. 

Mississippi has the lowest reimbursement rate from commercial insurance companies for inpatient services in the nation, according to a 2021 white paper by the actuarial and consulting firm Milliman. While UMMC maintains that BCBSMS is paying them well below market rates for other academic medical centers in the region, BCBSMS argues that agreeing to the increases would necessitate significant premium increases for their customers – despite a Mississippi Today investigation that revealed the insurer is sitting on an enormous reserve of money.

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