With no deal reached between UMMC, Blue Cross, Chaney announces network adequacy review of insurer

by Will Stribling, Mississippi Today
July 1, 2022

The 90-day grace period that allowed Blue Cross & Blue Shield of Mississippi customers to receive in-network rates at University of Mississippi Medical Center despite the hospital being outside the insurer's network expired on Friday, leaving patients with no options other than seeking their care elsewhere or taking on exorbitant out-of-pocket costs. 

UMMC, the state's safety net hospital, went out of network with the state's largest private insurer on April 1 due to disagreements over reimbursement rates and Blue Cross' quality care plan. 

The two parties agreed to enter mediation proceedings in late April, and had agreed on a mediator, Walter Johnson, by May 9, but Mississippi Insurance Commissioner says both parties are being “unreasonable,” indicating they are nowhere close to a deal.

When Blue Cross and UMMC used the mediation process to settle their contract dispute in 2018, it only took around 10 days to strike a deal. 

On Friday, Chaney sent a letter to Blue Cross, informing him that the Mississippi Insurance Department will be conducting a targeted market conduct examination of the insurer to determine whether it is in compliance with the state's network adequacy regulations. 

He also released a statement saying he has received many emails and calls from Mississippians caught in the middle of the dispute, and that he is disturbed by the impact the dispute is having on them.

“This is a stark reminder that the only ones impacted by the dispute are the consumers,” Chaney said in the statement. “As your Insurance Commissioner, I am doing everything I can to ensure that individuals continue to have access to the healthcare provider of their choice with minimal disruption.”

State law requires insurers to provide reasonable access to all types of care included in the insured's coverage plan. The concern is that without UMMC in its network, BCBS is not meeting this requirement due to the litany of specialty services UMMC provides that can't be found elsewhere in the state.

The areas of concern that Chaney signaled out in the letter are:

• The services provided at Blaire E. Batson Children's Hospital
• Level IV Neonatal Intensive Care Unit (NICU)
• Pediatric and Adult Congenital Heart Programs
• Children's Cancer Care Program
• Sickle Cell Anemia Program
• Heart, Kidney, Liver and Pancreas Transplant Program
• UMMC's relationship with Methodist Rehabilitation Center
• UMMC's Satellite Facilities

Chaney said that MID is in the process of appointing an examiner to conduct the review. If the review finds that Blue Cross is violating network adequacy regulations, Chaney can revoke the authority of the insurer to operate in Mississippi, impose a fine of up to $5,000 per violation, or both. 

It will likely be months before the review is completed and its findings are made publicly available. The Department completed a similar review of United HealthCare on Nov. 10, 2017, and the final report wasn't sent to the insurer until nearly four months later. 

UMMC spokesperson Marc Rolph declined to comment on the market conduct examination or confirm whether or not the hospital had renewed its contract with Chancellor Consulting Group, a California-based group that UMMC has been paying $50,000 per month since mid-September for help with its negotiation efforts. That contract expired Friday. 

Blue Cross did not respond to request for comment by the time of publication. Earlier this week, Cayla Mangrum, manager of corporate communications at Blue Cross, told Mississippi Today that they are prohibited from discussing mediation, though there is no legal requirement to not discuss the process. 

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