Blue Cross & Blue Shield of Mississippi

Chaney announces network adequacy review of Blue Cross amid dispute

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

The 90-day grace period that allowed customers to receive in-network rates at 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.

UMMC hosts job fair to combat nursing shortage

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Rising costs, contract work exacerbate nursing shortage for state’s safety net hospital

As part of efforts to address a shortage of nurses and respiratory therapists, the (UMMC) hosted a walk-in job fair on Monday. 

Pre-pandemic, UMMC would have an average of 30 open nursing positions at a time. That number has ballooned to over 200 over the past few years. 

For respiratory therapy, the hospital has 30 open positions in its adult hospital and 20 to 25 openings in its pediatric unit.

During the five-hour job fair, 16 applicants showed up and 11 were offered jobs on the spot. All accepted their offers. 

Patrice Donald, a registered nurse and manager of clinical recruitment and retainment at UMMC, said that the streamlined job fair process cuts down the time from the interview to hiring by around 42 days. 

Abigail May of Madison is one of UMMC’s recent hires. May will graduate from UMMC’s nursing school on May 27 and start her new job in the hospital’s neonatal intensive care unit just three days later. 

May said that her experience at UMMC, both as a student and a patient, along with the center’s focus on medical research, makes her want to stay in Mississippi. 

“I love helping the sickest of the sick patients,” May said. “I feel like that’s definitely my calling.”

Abigail May, nursing student, poses for a portrait after attending the University of Mississippi Medical Center’s walk-up nursing and respiratory therapy job interviews event, at UMMC’s Kathy and Joe Sanderson Tower in Jackson, Miss., Monday, May 16, 2022.

Mississippi has lost more than 2,000 nurses over the course of the pandemic due to burnout or higher paying jobs in other states, often in travel nursing. This strain is being felt all across the country, and the national shortage of nurses is likely to get worse over time. 

The aging population creates additional challenges:  An older population increases the demand for services, while also decreasing the number of working registered nurses as more retire from the workforce. 

A new report from the McKinsey consulting firm estimates that the United States may have between 200,000 to 450,000 fewer nurses available than are needed by 2025. The number of nursing school graduates who enter and stay in the workforce would need to more than double every year until 2025 to meet this demand. 

Some of the state’s funding was appropriated to help address this issue, including $40 million for nurse training at colleges and universities and $6 million for forgiving nurses’ student loans. 

But the effects of this investment won’t be felt for some time and does nothing for hospitals who need nurses immediately.

“It’s been challenging to recruit to retain, when there are so many travel agencies out there who can offer them a lot more money to leave the state … I’d be lying if I said that I hadn’t gotten an email or phone call asking what my interest is,” Gordon Gartrell, a nurse manager in UMMC’s pediatric intensive care unit, said.

However, UMMC has a competitive advantage over other health care providers in the state, Gartrell said, because it hosts  the state’s only children’s hospital. 

Gordon Gartrell, registered nurse and nurse manager talks about University of Mississippi Medical Center’s walk-up nursing and respiratory therapy job interviews, at UMMC’s Kathy and Joe Sanderson Tower in Jackson, Miss., Monday, May 16, 2022.

Nelson Weichold, UMMC’s chief financial officer, addressed the nursing shortage during a meeting of  the Institutions of Higher Learning’s Health Affairs Committee on Wednesday.

The labor costs for nurses have increased 14% when to the averaged revenue generated by all inpatient and outpatient services UMMC provides, according to Weichold. 

Weichold also presented data from the health care management consulting firm Kaufman Hall & Associates that showed the dramatic increase in the national average for contract nurse labor costs. Before the coronavirus pandemic, wage rates for contract nurses were almost double those for employed nurses. By March 2022, contract nurses were making nearly four times more than employed nurses.

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The increased labor costs, coupled with increased costs for supplies, are “squeezing” hospitals in a way that’s not happening in other industries, Weichold said. Airlines and fast food companies can pass those increased costs directly onto consumers in a way hospitals can’t.

“That’s not happening in the hospital industry, because, remember, we’re not charging customers, we’re charging insurance companies,” Weichold said. “And the insurance companies are very reticent right now to increase hospital payment rates.”

This tension between hospitals and insurance companies has been playing out openly in Mississippi over the past few months due to UMMC’s intense contract dispute with Blue Cross & Blue Shield of Mississippi, the state’s largest private insurer.

UMMC currently has around 3,000 nurses across its system, and around 100 of them are contract workers. Weichold said UMMC is planning on increasing nurse wages further when the hospital can wean itself off contract nurse labor.

Donald said that in addition to their normal nursing duties, the job descriptions for nurses includes the phrase “and all other duties as assigned,” an addition that has helped them stay afloat during the labor shortage. Nurses are often moved around to different units as needed. 

“We’ve got nurses floating around everywhere,” Tyler Fitzgerald, a nurse manager in UMMC’s transplant unit, said. “So we’ve managed. It’s been tough at times, and it remains tough, but we’re all here for the same reason.”

During the IHL meeting, Weichold said that the behavior of contract nurses has changed recently. While many were leaving to work in other states early in the pandemic, now they’re leaving a job at one hospital to do contract work at another hospital in the same city. According to Weichold, most UMMC nurses who leave for contract work return to the hospital within three to four months.

Fitzgerald experienced that trend firsthand.

Fitzgerald said his team lost three full-time nurses during the pandemic who have recently returned to UMMC.

“We have people that leave and then come back,” Fitzgerald said. “Everybody always comes home.”

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

Reeves vetoes $50M appropriation to UMMC

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Gov. Tate Reeves vetoes $50M appropriation to UMMC

Gov. Tate Reeves announced Tuesday he had partially vetoed an appropriations bill for the , citing the state-owned hospital’s ongoing contract dispute with Blue Cross & Blue Shield of Mississippi.

Reeves’ partial veto of Senate Bill 3010 withholds $50 million of federal funding appropriated to UMMC by the state Legislature for the completion of capital improvements to the patient care facilities and operating suites of UMMC’s adult hospital.

The governor justified the veto by arguing that while UMMC’s teaching center is largely funded by the state, the hospital is not. He accused the hospital of “willingly” turning away patients on private insurance, a reference to UMMC’s contract dispute with Blue Cross that has resulted in the hospital going out of network with the insurer.

Though Blue Cross insurance is not currently accepted at UMMC, the hospital is not turning away patients covered by that insurer. Instead, those patients must pay for their care out of pocket, but at a discounted rate.

“There is little reason that Mississippi taxpayers should radically increase the commitment to further subsidize the operations of UMMC to the detriment of competitors,” Reeves said in a statement. 

READ MORE: Blue Cross, UMMC agree to mediation to settle contract dispute

UMMC officials declined to comment on what this loss of funding would mean for the planned improvements to the hospital. The hospital is receiving other ARPA funding for improvements to teaching facilities, including $55 million for its School of Nursing building. 

While the governor vetoed the appropriation for UMMC, which is tasked with treating many of the state’s uninsured, he did approve a $7 million appropriation for Memorial Hospital.

The legislation, signed into law earlier this week by Reeves, provides $7 million to Gulfport Memorial for the pediatric multispecialty center on or near the hospital’s campus “in collaboration with University of Mississippi Medical Center and Gulf Coast Community College.”

UMMC is a public hospital owned by the state. Gulfport Memorial is a public not-for-profit hospital owned jointly by the and .

Reeves has publicly clashed with Dr. LouAnn Woodward, vice chancellor of health affairs and medical school dean at UMMC, over his handling of the pandemic. Meanwhile, Kent Nicaud, the chief executive officer of Memorial Hospital of Gulfport, hosted a fundraiser at his home for the governor in the midst of a surge in the pandemic. At the time of the event, experts were urging caution during social gatherings as most hospitals in the state were filled to capacity.

Nicaud served on Reeves’ state finance committee for his 2019 gubernatorial campaign and has donated tens of thousands of dollars to the governor. Nicaud’s son has also been a significant campaign donor to Reeves.

The state constitution gives the governor partial veto authority, but that authority had been significantly limited by the courts in past rulings. In rulings going back to the 1800s, state courts had significantly limited the governor’s authority to veto portions of appropriations or spending bills until a 2020 Supreme Court decision.

The state Supreme Court had previously ruled that governors could not veto “the purposes or conditions” of appropriations bills. Instead, the governor had to veto entire sections of a bill, not just individual earmarks.

But in the landmark 2020 decision, with six of the nine justices concurring, the court reversed those previous decisions. The state’s highest court went a step further, with six of the nine justices saying that legislators did not have standing to challenge a governor’s partial veto in court.

This means it would be up to UMMC or the Institutions of Higher Learning to file a challenging the constitutionality of the partial veto.

If the UMMC veto is not challenged, that $50 million will return to the state’s pool of ARPA funds, which the Legislature has until 2024 to appropriate. 

The 2020 partial veto also involved health care and another round of federal coronavirus-relief spending. In that instance, the governor vetoed a $2 million appropriation earmarked to then-shuttered North Oak Regional Medical Center in Tate County that it would receive should it reopen. He also scrapped a $6 million to a program designed to combat health care disparities in poor and minority communities.

Reeves also argued in his statement that building improvements are not the best way to spend $50 million in pandemic relief funding, citing a greater need of health care providers statewide for more staffing.

“That money would be better served in one of the programs that I recently signed to incentivize more training around the state for doctors, nurses, and other healthcare professionals,” Reeves said. “After all, throughout COVID, we always had adequate bed capacity for patients. The central challenge was always the hospitals’ inability to properly staff the beds.” 

The governor’s claim that there were always enough beds for COVID-19 patients is inaccurate. While staffing shortages were, and are still, a major issue for hospitals statewide, capacity issues also emerged during the delta wave of the pandemic. 

UMMC had to construct two separate field hospitals in parking garages during the delta variant surge last August to handle patient overflow. 

Mississippi has lost more than 2,000 nurses over the course of the pandemic due to burnout or higher paying jobs in other states, often in travel nursing. Some of the state’s ARPA funding has been appropriated to help address this issue, including $40 million for nurse training at colleges and universities and $6 million for forgiving nurses student loans. 

Reporter Geoff Pender contributed to this report.

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

Blue Cross, UMMC agree to mediation to settle dispute

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Blue Cross, UMMC agree to mediation to settle contract dispute

Blue Cross & Blue Shield of Mississippi and have agreed to utilize a mediation process to settle the contract dispute that has left the state’s largest hospital 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 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.

Blue Cross members agonize over losing trusted doctors -Mississippi Today

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With UMMC out of network, Blue Cross members agonize over losing the doctors they trust

Christy Van of Jayess didn’t know what was wrong with her son. It was 2020, and her six-year old, Cooper, was living with stomach issues that put him in near-constant pain and limited his ability to have a normal childhood. 

They weren’t getting any answers from Cooper’s pediatrician or a gastroenterologist in Flowood.

“They tried to help him, but I really felt like they weren’t taking me seriously, and I knew that something else was wrong,” Van said. 

That changed when her son was referred to Dr. Michael Nowicki, a children’s gastroenterology specialist at . After she told Nowicki about Cooper’s symptoms, he ordered a sweat test. 

With that one test, Nowicki was able to diagnose Cooper with cystic fibrosis, a disorder that causes severe damage to the lungs, digestive system and other organs. The condition affects the cells that produce mucus, sweat and other bodily fluids, leading these fluids to thicken and block critical bodily functions. 

The disorder manifested in Cooper as a pancreatic deficiency that prevents him from properly digesting fats. 

“I’ve never been so shocked in my life. It was devastating for us,” said Van. “At first we were just so overwhelmed, but those doctors at UMMC took care of us.” 

Cooper will have to visit a hospital every three months for the rest of his life. He currently sees Dr. David Josey, a pediatric pulmonologist at UMMC, along with a slew of specialists who help manage different facets of living with cystic fibrosis. 

“It was just so devastating to me to hear the word ‘forever,’ but Cooper doesn’t dread (going to the doctor)… Cooper just really loves him (Dr. Josey) and his whole team.”

Christy Van and her son, Cooper Van, 8, demonstrate how to use high-frequency chest wall oscillation while at home in Jayess, Miss., Thursday, April 21, 2022. The vest clears the lungs of excess mucus for cystic fibrosis. Cooper was diagnosed with the disorder when he was 6 years old.

But now the future of Cooper’s care is uncertain. He is one of tens of thousands of Mississippians who have been impacted by UMMC going out of network with his family’s insurer, Blue Cross & Blue Shield of Mississippi. The dispute between the two stems from disagreement over reimbursement rates and Blue Cross’ quality care plan, which measures hospital performance and whether services provided to patients are adequate.

Cooper can continue receiving care at UMMC through his parents’ Blue Cross plan until July 1. Then, they have to make some tough decisions. Paying thousands of dollars per month out-of-pocket each month isn’t an option for a single-income household like his.

UMMC is the only accredited cystic fibrosis care center in the entire state of Mississippi.

Cooper has a daily at-home care routine that allows him to live a normal life. Every morning when he wakes up and before he goes to bed he uses a high-frequency chest wall oscillation device, or a vest that vibrates at a high frequency to clear his  lungs of excess mucus. 

He also takes a variety of medications that have cleared up his digestive issues. 

The treatments prescribed by his UMMC doctor have allowed him to flourish and grow to be an energetic eight-year-old who loves to play sports, his mom said. 

“It’s changed his life,” Van said of Cooper’s treatment.  “You couldn’t look at him and tell that there was anything wrong with him.” 

Switching Cooper’s care to a hospital in network with  Blue Cross isn’t an easy fix. UMMC is. The closest alternatives are the University of Alabama Medical Center in Tuscaloosa and Tulane Medical Center in New Orleans. 

Though it comes with added financial burdens, the only option the Vans see is buying Cooper a separate health insurance plan that’s in UMMC’s network. 

“That is where I want him to be,” Van said. “They saved his life and have given him back his quality of life… we’re just hoping and praying that it’s going to work itself out.”

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. Mississippi Insurance Commissioner Mike Chaney on Thursday penned a letter urging the two parties to utilize the same mediation process that was used to settle their contract dispute in 2018.

UMMC is asking Blue Cross for substantial increases to inpatient, outpatient and professional reimbursement rates, some as large as 50%. UMMC maintains it’s asking for below-market rates for academic medical centers. Blue Cross officials say that steep rate hikes would necessitate a substantial increase in customer premiums – despite a a Mississippi Today investigation that revealed the insurer is sitting on an enormous reserve of money. 

Medications for cystic fibrosis are pictured here in Jayess, Miss., Thursday, April 21, 2022. Cystic fibrosis is a disorder that causes severe damage to the lungs, digestive system and other organs in the body.

Nicolette Brokaw of Vicksburg has been going to UMMC since she was a baby. Now an adult, she has been seeing the same doctor for a decade, who treats her for an Alpha-1 antitrypsin deficiency (AAT deficiency), a condition that significantly raises a person’s risk for liver and lung disease. 

Six months ago when Brokaw received a letter from Blue Cross that alerted her to the contract dispute from UMMC, she decided it wasn’t worth worrying about. She couldn’t control the outcome, and they had resolved similar disputes in previous years.

Now, with UMMC out of network, she’s dreading the laborious and emotionally draining process of finding a new doctor who she trusts.

“I’m going to have to go through the process of giving my whole life story again,” Brokaw said. “They’re going to look at me like I have six heads, and I don’t want to go through that.”

An even bigger worry is finding a new doctor for her  three-year-old son with autism, Liam, who has been receiving speech and occupational therapy at UMMC. Recently she’s become worried that Liam is having absence seizures, which are common in autistic children and involve brief, sudden lapses of consciousness. 

Brokaw said Liam sometimes stares off into space for a bit, and her intuition tells her it’s not normal distraction. If she could, Brokaw would take Liam to Dr. Lamar Davis, a children’s neurologist at UMMC, who Liam has seen before.

“I wish I could go back to him for this problem, but I can’t because I can’t afford to pay out of pocket for a neurologist,” Brokaw said. “… I wish money wasn’t an object, but it is.”

Currently, Brokaw is trying to get Liam health coverage under a special eligibility category of in Mississippi called Disabled Child Living at Home. 

Although Liam has already been diagnosed with autism, due to Social Security disability rules, the Mississippi Division of Medicaid is requiring that he receive a behavioral evaluation with an autism rating scale to become eligible for coverage. 

“The first diagnosis we got was black and white, but it’s not good enough,” Brokaw said. “It’s ridiculous.”

Brokaw is considering taking Liam to Ochsner Medical Center in New Orleans, but that comes with its own financial challenges. Even if she’s able to get an appointment there, the added gas and hotel costs are going to put added strain on her family, which relies solely on her husband’s income. 

What really bothers Brokaw is the knowledge that the people making the business decisions that have put the health of her family, and others at risk are insulated from the consequences of those decisions, she said. 

“I can’t imagine what these other people who basically live at the hospital are going through,” Brokaw said. “It’s these people that are taking the hit, not the CEO or the board members. They’re not going to have to worry about putting gas in their car. They go back to $500,000 homes. They can go to the doctor whenever they want to.” 

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

Blue Cross Blue Shield surplus outpaces other insurers

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Blue Cross is sitting on a huge pile of money. In some states, consumers would get it back.

Janah Garriga’s 12-year-old daughter, Joshlyn, was diagnosed with T-cell leukemia in February. Joshlyn loves her doctors and nurses at the

But when Garriga took her daughter to an appointment in early April, she was asked to sign a letter accepting full financial responsibility for all the costs of her daughter’s treatment because the hospital recently went out of network with Blue Cross and Blue Shield of Mississippi, her insurance company. 

The letter turned out to be a mistake on the hospital’s part. Because is her daughter’s secondary insurer, Garriga fortunately won’t be on the hook for out-of-pocket cancer treatment — unlike many other families across the state.  

But after so much confusion, she still worries something could go wrong, complicating her daughter’s cancer treatment. 

As the stalemate between the state’s largest hospital and its largest insurer drags on, some of the most gravely ill Mississippians are reaping the consequences, forced to delay needed care, travel out of state and leave doctors with whom they’ve built relationships over years.

Blue Cross of Mississippi is refusing to pay UMMC more for its services. Meanwhile, the for-profit mutual insurance company is sitting on an enormous reserve of money, a Mississippi Today investigation shows, hiding its top leaders’ compensation amounts and transferring its members’ power to longstanding company executives.

Most policyholders caught in the middle of the insurer’s dispute with UMMC are unaware that they have signed away their right to participate in the board’s decisions and are surprised to learn that Blue Cross holds a surplus of hundreds of millions of dollars.

When Garriga learned about the size of Blue Cross of Mississippi’s surplus, she was speechless for a moment. 

“It’s greed,” she said. “… And it’s sad that it’s people’s life at stake.”

Financial records show the company has accumulated far more than what regulators require to protect consumers, and perhaps the largest such surplus by percentage of any Blue Cross company in the country.

The value of the company’s surplus stands at about $750 million, about eight times the level that would trigger regulators to take action and about four times the level Blue Cross sets as the floor for companies with its trademark. 

“That is extraordinarily high for a company of that size,” said Brendan Bridgeland, an attorney and director of the Boston-based Center for Insurance Research, which advocates on behalf of insurance consumers. “It seems like (policyholders) are probably paying more than they should for their health insurance.”

Bryan Lagg, senior vice president of consumer markets and sales at Blue Cross of Mississippi, said the reserves are a “critical component” of the company’s financial security and its ability to pay for future services.

“This is even more important today due to the cost of health care services,” Lagg said in a statement. “We take great pride in knowing payments for health care services (for our Members and Network Providers) will continue even in the event of a natural disaster, economic crisis or the uncertainties of a pandemic.”

The surplus has attracted little public scrutiny in part because of a governance structure that curtails oversight.

As a mutual insurance company, Blue Cross of Mississippi is supposed to be owned by its policyholders, who can participate in meetings and hold company executives accountable. But policyholders give up that right when they sign up for coverage and can earn it back only by mailing a written request to the company's headquarters. That means a handful of board members have been making decisions that affect hundreds of thousands of Mississippians with almost no oversight from either investors or policyholders.

Blue Cross officials did not answer questions about the structure of the company, including how many members have filed written requests or what the process is after a request is filed.

Consumer advocates say the size of the surplus means the company could afford to pass savings on to consumers by reducing rates. Instead, Blue Cross has raised premiums for many of its consumers in recent years. 

In January 2020, for example, it hiked fees for small business plans by 13%, affecting 55,000 Mississippians. Premiums for two types of individual health plans were also increased 16% in the same time frame. The company cited a significant underwriting loss, which occurs when a company has to pay more in claims than it expected. 

Chuck Bell, programs director at the advocacy organization Consumer Reports, has studied health insurance surplus levels around the country. After reviewing the surplus level held by Blue Cross of Mississippi, he said he sees a role for state oversight. As a for-profit insurer, the company could return excess surplus to the community by lowering rates. 

“We think it's appropriate for the state to put some guardrails around how much surplus can be accumulated, and not leave it to the boards and managements of the health plans, who may or may not take action,” he said.

After raising rates in 2020, the insurance company went on to triple its profits that same year, according to its annual statement. The insurer made over $60 million that year to around $20 million in 2019. 

Officials with the company said the increase was due primarily to stock investment performance and a delay in the impact of COVID-related claims. The company’s 2021 net income was just under $17 million with a “significant underwriting loss,” said Cayla Mangrum, manager of corporate communications for the company.

Lagg said the company uses the vast majority of customers’ premiums to pay their health care costs, meeting and often exceeding federal requirements for that metric. Instead of relying on premiums to make money, the company says it profits through “administrative efficiency and investments.” 

When an individual signs up for insurance with Blue Cross of Mississippi, a seldom-noticed part of the policy states the person transfers that power to company executives. 

“As a part of the Subscriber’s enrollment for membership and coverage with … he or she has appointed Blue Cross & Blue Shield of Mississippi’s President, Executive Vice President, and Secretary as proxies to cast his or her vote, upon concurrence of at least two of them, on all matters arising at membership meetings,” the policy states. 

If the policy holder wants to challenge the proxy, he or she must file a “written revocation” with the company.

Officials at Blue Cross of Mississippi declined to answer Mississippi Today’s questions about this policy.

Typically, Bridgeland said, a mutual company will notify policyholders each year about an annual meeting or upcoming vote and request a proxy designation – not require customers to appoint the executives as proxies in perpetuity when they sign up for coverage. 

Bridgeland said he had never seen a mutual insurance company with such strict limits on policyholder participation. 

“It runs against any sort of corporate governance recommendations I’ve seen and is very much out of line with best practices,” he said. “And the reason is because you don’t want to make management completely insulated, which this effectively does.”

In theory, a mutual company puts policyholders in charge of executives. But Bridgeland said things rarely work out that way, because it’s difficult for individual policyholders to exercise power, so executives treat the company like a “personal fiefdom.” At Blue Cross Mississippi, the proxy policy has given the board total control and almost no oversight. 

The composition of the board of directors hasn’t changed much this century, for example. From 2005 to 2017, there was just one addition: Mary Carol Pigott, the chief operating officer in 2005, became CEO and president and joined the board of directors by 2012. Richard John Hale, her predecessor as CEO, then became chairman of the board. 

When Blue Cross converted from a nonprofit to a for-profit mutual company in 1995, it had a 15-member board. By the mid-2000s, it had only seven or eight members. According to the rules established in 1995, board members vote to appoint new members.

“It’s sort of like an old Soviet Russia election,” Bridgeland says. “The party tells you who to vote for. So there’s gonna be zero change.”

Blue Cross officials also declined to answer questions about why its board membership has dwindled over the years.

In order to guarantee an insurance company can pay out all the claims that could come its way, regulators establish a certain amount of capital they must hold, similar to a rainy day fund. The size of a company’s surplus is expressed as a percentage of the baseline requirement, called the risk-based capital ratio. 

Generally insurers try to hold at least three times as much capital as the minimum requirement– a ratio of 300%. 

If the ratio is too low – meaning the company has fewer assets and more liabilities – the company risks insolvency and its customers could get hurt. But if the ratio is too high, the company may be hoarding customers’ cash with no benefit to them, especially if it raises their rates anyway. 

At Blue Cross of Mississippi, the ratio stood at 1,578% at the end of 2021. United, the next largest insurer in the state, held a ratio of 1,078%, according to financial documents Mississippi Today obtained. The ratio for Ambetter, which sells plans on the health insurance marketplace, was 745%. 

The Mississippi company’s surplus is significantly larger than those of its Blue Cross peers in neighboring states. Louisiana held a ratio of 944% at the end of 2021, and Arkansas of 751%. The for-profit Anthem Blue Cross & Blue Shield of Georgia held a ratio of 506%. 

Officials at the state insurance department said there is no ceiling for the surplus, so Blue Cross of Mississippi  isn’t violating any rules or laws. 

"Blue Cross & Blue Shield of Mississippi’s financial strength, administrative efficiency and rating discipline are for the benefit of our Members and should not be used to mislead or distract from the issue and why UMMC made the decision to become non-network," Lagg said. "The issue is the cost and quality of health care services for our Members and UMMC’s outrageous demands which will only further increase costs unnecessarily."

But the size of the company’s surplus far outpaces industry averages. A 2019 report by the Vermont Department of Financial Regulation looked at surpluses held by 16 Blue Cross companies around the country. Mississippi’s surplus was the largest, at 1700%. The second-largest, in Idaho, was 1321%.

Ten of the companies held a surplus below 1000%. The average was 937%. 

Blue Cross' unusually large surplus has held for years. From 2013 to 2017, Mississippi’s surplus never dipped below 1600% and was consistently the highest in the group the Vermont report studied. 

Though Mississippi’s regulations haven’t stopped Blue Cross from amassing this rainy day fund, regulators in other states have imposed limits on insurers’ surplus levels. 

The Pennsylvania legislature gave regulators the authority to review surplus levels at Blue Cross insurers, which are nonprofit, and require them to justify or reduce any surplus beyond a certain level. Most recently, that cap was set at 750% for larger plans or 950% for smaller plans, which experience more volatility and thus need a larger cushion. 

Blue Cross is by far the biggest private insurer in Mississippi, with about 56% of the market. United, the second-largest, claims only 17%. 

The size of the company’s surplus “would suggest to me that there is available money here, that in the hands of good advocates, maybe ought to be addressed to health care needs,” said Walter Smith, executive director of the nonprofit group D.C. Appleseed. 

Smith’s organization won a legal battle with a local nonprofit Blue Cross affiliate that had amassed “excessive” surpluses with a smaller pile of extra assets than what Blue Cross of Mississippi  currently holds. The settlement agreement required the company to set up a $95 million fund to support public health in D.C. 

Because Blue Cross of Mississippi is a for-profit company, it’s not directly comparable to the D.C. case his organization spearheaded, which involved a nonprofit founded as a “charitable and benevolent institution,” Smith said. But consumer advocates say if a for-profit company has a huge surplus, it shouldn’t need to raise rates, and in some states regulators could stop it from doing so. 

But in Mississippi, state law prohibits regulators from using an insurer’s surplus level to justify approving or denying a rate increase. And moreover, the state insurance commissioner does not control rates on group and self-funded plans, according to Commissioner Mike Chaney.

“The only rate authority we have for Blue Cross and Blue Shield is for individual policies, and they have less than 30,000 people (with those plans) in the state,” said Chaney. 

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

How much do Blue Cross, UMMC leaders make? It’s a secret.

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How much do Blue Cross, UMMC leaders make? In Mississippi, that’s a secret.

While 50,000 Mississippians face the prospect of going without affordable medical care thanks to a contract dispute between the state’s largest hospital and insurer over reimbursement rates, the salaries for executives at both entities are shielded from the public.

Blue Cross & Blue Shield of Mississippi sued the state over a decade ago to make sure its executives’ compensation could not be disclosed, and the — despite being under the purview of the Institutions of Higher Learning and receiving state and federal funding — cites a broad exemption in state law when withholding its top administrators’ salary information.

Blue Cross & Blue Shield of Mississippi is required to file information about its executives’ compensation as part of its annual report to the Mississippi Insurance Department. But in 2009, the insurer sued the department to stop it from releasing that information to the public.

Several current executives at the company — Carol Pigott, the CEO; Thomas Fenter, the chief medical officer; and Bryan Lagg, senior vice president of consumer marketing and sales — are listed as plaintiffs in court filings.

Chancery Court Judge Patricia D. Wise sided with Blue Cross, ordering the department “to withhold from public disclosure all information concerning the compensation of BCBSM executives.” Wise determined that the Insurance Department didn’t use the information to carry out its duties, so it isn’t a public record, and that disclosing the salary information would violate “the privacy rights of the individual plaintiffs/executives.”

Top executives make seven figures, a longtime former employee of the insurance company told Mississippi Today.

The median household income in Mississippi is around $46,000.

“Salaries and employee compensation of all employees at BCBSMS is not pertinent to the contract dispute with UMMC, and simply distracts from what is really important — high-quality, cost-effective care for our Members,” Cayla Mangrum, manager of corporate communications for the company, said in a statement to Mississippi Today. 

But Mississippians faced with exorbitant costs or the added burden — financial and otherwise — of driving elsewhere for care might see it differently.

Court Order Bcbs by kate on Scribd

Carmen Balber, executive director of the nonprofit consumer advocacy group Consumer Watchdog, said that health insurance is essentially a public good, even when delivered through private companies. 

“At the end of the day, we’re paying for those salaries,” she said, speaking about health insurance companies generally because she doesn’t have specific knowledge of BCBS Mississippi. “I’m certain that any consumer who’s had issues with their health insurance, paying for what they need, would be very interested to know that the CEO of the company was making $1 or $2 or $6 million a year.” 

In many other states, that information is public record. In California, for example, an executive compensation report published annually on the company’s website shows their top executive made $6.4 million in 2020. In Michigan, the company’s CEO made $15.6 million in 2021. A spokesperson for the Blue Cross Blue Shield Association, the umbrella group for 34 different BCBS companies, said they did not have information about the number of states in which BCBS executive compensation is withheld from the public.

A 2016 survey by the National Association of Insurance Commissioners of its members around the country found that insurance company compensation figures were kept confidential in at least 12 states, including Mississippi. 

The company awards yearly bonuses to employees — as much as six figures for executives — around March each year, said the former BCBS employee, and the amounts of the bonuses also increased in recent years.

The company told Mississippi Today the bonuses are “an important part” of incentive-based compensation. 

“Blue Cross & Blue Shield of Mississippi (BCBSMS) is proud of our employee incentive program because it rewards (and thanks) our employees for their individual performance and contribution to the achievement of the Company’s health and wellness goals for our Members,” Mangrum said. 

Though the University of Mississippi Medical Center receives about 9% of its funding from the state, the hospital shields its executives’ compensation, too. When Mississippi Today requested hospital salary information last year, UMMC invoked the broad hospital exemption in the state’s public records law to withhold the information. When reporters asked the Institutes of Higher Learning for the salary information this week, a spokesperson cited the law and said UMMC employees’ salaries are exempt from disclosure.

The salary for Dr. LouAnn Woodward, vice chancellor of health affairs and dean of the school of medicine, was $700,400 a year in 2016, according to a news article.

A 2021 report by the Economic Research Institute showed the average nonprofit hospital CEO made $600,000 in 2018. 

On March 31, Blue Cross and UMMC missed their deadline to sign a new contract, forcing tens of thousands of patients to pay higher costs for out-of-network care at the hospital, or go elsewhere. UMMC maintains it has been underpaid relative to other academic medical centers in the region and is asking for a 30% overall increase in reimbursement rates from Blue Cross in the first year of a new contract. Blue Cross argues that’s too much. 

Contract disputes between the two have been tense in the past, but this is the first time UMMC has gone out of network with Blue Cross, hospital officials said.

In 2009, reporters from WLBT requested information on Blue Cross Blue Shield executive compensation from the Insurance Department, on behalf of several policyholders who wanted to know where their money was going. 

Blue Cross then sued the Insurance Department, triggering the court order in their favor. 

Last week, Mississippi Today filed a records request with the Mississippi Insurance Department for the executive compensation information Blue Cross Blue Shield is required to file with the state annually. The department responded that the 2009 court order prohibits it from fulfilling the request.

“In accordance with the Court’s directive, MID is prohibited from releasing the aforementioned information which is the subject of your request,” wrote deputy commissioner Mark Haire.

Historically, public hospital records were exempt from public disclosure. But after Health System in secretly stopped paying into its pension system from 2009 to 2014 as it faced a hidden financial crisis, legislators moved to require greater transparency. Public hospitals are now required to share board meeting minutes and financial records. But employee salaries and personnel records are still exempt.

In a statement to Mississippi Today, Blue Cross said they make money not from customer premiums but from “administrative efficiency and investments.” They also said they outperform federal requirements for the percentage of customer premiums they spend on claims, a figure called the medical loss ratio. For large employer groups, the requirement is 85%; Blue Cross says it hit 94%. For individuals, the requirement is 80%, and Blue Cross reached 99%. 

“Our medical loss ratio performance clearly illustrates Blue Cross & Blue Shield of Mississippi’s ability to ensure the vast majority of the Member’s premium is for health care costs,” the statement said.

In other states, legislatures have passed laws preventing disclosure of insurers’ executive compensation. Alabama, for example, used to release the information publicly. In 2015, following lobbying from the insurance industry, the law changed to make salaries confidential. 

Alabama health care attorney Jim McFerrin told AL.com that making salary information public gave customers more information about where their money was going and could allow them to take legal action in certain situations – like, for example if they believed a rate increase was unreasonable.

“A decrease in transparency means a decrease in accountability,” he told the site. 

Mississippi Today reporter Molly Minta contributed to this report.

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

How UMMC going out of network with BCBS affects you

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Have Blue Cross Blue Shield insurance? This is what UMMC going out of network means for you.

For the first time in state history, , the state’s largest hospital, has gone out-of-network with Blue Cross & Blue Shield of Mississippi, the state’s largest insurer. 

So now what?

Who is exempt from the change

There are three groups of people that UMMC’s out-of-network status does not apply to, or will receive in-network benefits for a few extra months:

  1. Those enrolled in the Mississippi State and School Employees’ Health Insurance Plan will not be affected. Though that plan is administered through BCBS, the current dispute only affects the insurer’s commercial insurance plans.
  2. Patients who come into UMMC’s emergency room or are transferred from another hospital will still have their current reimbursement rates honored. 
  3. Patients for which UMMC has a continuity of care obligation. UMMC can’t stop honoring in-network rates for, say, a pregnant woman in her last trimester of pregnancy or a cancer patient who is in round two of 12 rounds of chemotherapy. In those cases, their Blue Cross reimbursement will be accepted. For these patients, this period of coverage will expire 90 days from April 1. 

What this means for non-emergency care

Blue Cross & Blue Shield of Mississippi has informed its customers that the insurer will continue to provide network benefits to UMMC patients – meaning BCBS is still offering to pay the in-network rate for a patient’s care. 

However, this will not prevent UMMC patients from paying highly inflated out-of-pocket costs for non-emergency care.

Blue Cross has instructed its customers to provide them with written direction to make benefit payments to UMMC. If UMMC were to accept payment from BCBS in this situation, UMMC could not bill patients for the difference between the reimbursement and cost of the service due to a 2013 Mississippi law that banned balance billing

However, UMMC maintains that they will not accept payments from BCBS. 

“If we were to do that (accept the payment from BCBS), then they would be able to pay us whatever they wanted in perpetuity, and we wouldn’t be able to do anything about it,” Dr. Alan Jones, UMMC associate vice chancellor for clinical affairs, told Mississippi Today in March.

Blue Cross & Blue Shield of Mississippi believes the hospital is legally required to accept its payment or consider the services as paid in full – an interpretation with which both UMMC and Mississippi Insurance Commissioner Mike Chaney disagree.

“Blue Cross & Blue Shield of Mississippi Members may direct us to pay UMMC directly for services it rendered.  Blue Cross & Blue Shield of Mississippi (BCBSMS) is required to honor the direction of payment, and UMMC is required to accept BCBSMS’ payment as payment in full for covered services and even if UMMC rejects BCBSMS’ payment, the statute provides ‘that payment shall be considered payment in full to the provider, who may not bill or collect from the insured any amount above that payment [other than deductible and coinsurance/copay]….,” Cayla Mangrum, manager of corporate communications for the company, said in a statement to Mississippi Today last week. 

“UMMC’s stated intention to refuse to accept payment directly from Blue Cross & Blue Shield of Mississippi when a Member has directed us to pay UMMC is not in compliance with the consumer protection statute and would deprive our Members of a right they are clearly provided under Mississippi law,” she said.

Chaney weighed in on this interpretation: “There’s nothing in the code section that requires UMMC to accept payment from BCBS.”

Marc Rolph, executive director of communications and marketing for the hospital, echoed Chaney.

“UMMC does not believe that an insurance company has the unilateral right to dictate the business practices of a provider,” said Rolph.

According to UMMC, patients will instead have to file any claims directly with BCBS and pay the UMMC bill themselves. The reimbursement a patient will receive directly from BCBS will be less than their UMMC bill. 

UMMC has said it will offer BCBS patients a discounted rate on the care they receive, but even with this discount, their care will still cost significantly more than if BCBS was still in-network.

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

UMMC and Blue Cross & Blue Shield of Mississippi in contract dispute

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rssfeeds.clarionledger.com – Mississippi Clarion Ledger – 2022-03-30 21:00:19

The University of Mississippi Medical Center in Jackson, Miss.

University of Mississippi Medical Center and Blue Cross & Blue Shield of Mississippi are in a battle over a contract renewal that could keep some Mississippi Blue Cross customers from being able to access UMMC’s services in-network after April 1.

UMMC wants Blue Cross to pay the hospital system more for its services to Blue Cross of Mississippi members. Blue Cross says those demands would…

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