Insurance chief Mike Chaney says UMMC is violating state law in BCBS dispute

by Will Stribling, Mississippi Today
July 27, 2022

Insurance Commissioner Mike Chaney says he believes that the University of Mississippi Medical Center (UMMC) is violating state law by turning patients away from the state's only safety net hospital. 

The state insurance department, according to Chaney, has received numerous complaints from UMMC patients who have been told by their doctors that they cannot receive care at the hospital because they are insured by Blue Cross & Blue Shield of Mississippi.

UMMC has been out of network with Blue Cross, the state's largest insurer, since April 1 due to disagreements over reimbursement rates and Blue Cross' quality care plan.

Chaney said that he believes UMMC turning away patients would violate Mississippi Code 37-115-31, which states that UMMC “shall be utilized to serve the people of Mississippi generally.”

“If you are the university hospital, you have a moral and ethical obligation to take care of Mississippians and a statutory requirement that you do so,” Chaney said.

Chaney said that his office has forwarded several of these allegations to UMMC and “other proper authorities that can enforce the law.”

Under federal law, public hospitals like UMMC may not deny a patient care based on the ability to pay or who the insurance provider is. UMMC and Blue Cross are still honoring in-network rates for Blue Cross patients who come into UMMC's emergency room. Mississippi Today has not independently confirmed any instance of UMMC turning away a patient in an emergency situation. 

UMMC's official policy is that each Blue Cross customer must sign a form that confirms the patient is aware that UMMC will not accept payment from Blue Cross for any elective services and that they will be responsible for their medical bills if they continue their care at the hospital. With Chaney's allegations, it is unclear if this policy is being followed with each Blue Cross patient. 

“The problem is the people at the top that we deal with (at UMMC) are telling us one thing when what's happening down at the bottom is totally different from what they're telling us,” Chaney said. 

UMMC spokesperson Marc Rolph said the hospital had “no comment” on Chaney's allegation that UMMC is violating state law. 

Federal law required UMMC to continue honoring in-network rates for certain patients for a 90-day period after it went out of network, but that “continuity of care” grace period expired on July 1. Since then, children with rare genetic conditions and transplant patients have been forced to seek their care out of state or switch to another insurer. 

Chaney has also previously alleged that without UMMC in its network, Blue Cross is violating network adequacy requirements. There are a litany of specialty services UMMC provides, such as its children's cancer care program and transplant programs, that can't be found anywhere else in the state. State law requires that Blue Cross customers have reasonable access to these services if the services are covered by their insurance plan.

Chaney launched a network adequacy review of Blue Cross on July 1, the results of which likely won't be finalized or made publicly available for months. 

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