University of MS Medical Center to drop state's largest private insurance provider

University of MS Medical Center to drop state's largest private insurance provider

MISSISSIPPI (WLOX) - Mississippi's largest hospital says it will stop accepting policies from Blue Cross & Blue Shield of Mississippi, the state's largest private insurer, citing contract dissatisfaction.

According to the University of Mississippi Medical Center, the contract between the hospital and Blue Cross & Blue Shield of Mississippi will be terminated on June 30, 2018. However, the hospital hopes to come to an agreement on a new contract in the next two months.

Without a new agreement in place by June 30, UMMC will become out-of-network for BCBSMS customers, and those patients may face higher out-of-pocket costs.

Medical center officials say they want a different contract.

"We are committed to negotiating with Blue Cross in good faith," said Dr. Charles O'Mara, UMMC associate vice chancellor for clinical affairs. "However, it's important to understand that our current agreement with Blue Cross was developed 28 years ago when UMMC and the healthcare industry were vastly different.  Most troubling, the base contract from 1990 allows Blue Cross to make any changes it wants to the terms of the agreement – including what it pays us for services we deliver to patients – without consulting UMMC."

Blue Cross spokeswoman Meredith Bailess says the medical center, not the insurer, is at fault. She says the medical center doesn't respond to the insurer's focus on health outcomes and controlling costs.

Insurance Commissioner Mike Chaney said:

My primary concern in this situation is that patients continue to receive access to quality healthcare without suffering financial penalties.  As Commissioner of Insurance, I am prohibited by regulation from acting to mediate or settle disputes between a health carrier and a medical provider arising under a provider contract.  I urge both BCBS and UMMC to work diligently to find common ground prior to the June 30th termination date.  It is my expectation that should the contract actually terminate, BCBS will continue to pay network benefits and UMMC will refrain from balance billing patients until the parties resolve their differences.

UMMC says they hope nothing changes for its patients and are optimistic that an agreement can be reached.

"During the coming weeks, as we continue to negotiate with BCBSMS, absolutely nothing will change for our patients," said Dr. Charles O'Mara, UMMC associate vice chancellor for clinical affairs. "We encourage Blue Cross members to continue to visit their UMMC care providers just as they always have. Our goal is to maintain business as usual, so our patients do not experience any disruption in their care."

As the state's only academic medical center, UMMC offers the only Level I trauma center and children's hospital in the state, the only organ transplant service, and one of the most extensive telehealth networks in the nation. In March, UMMC also partnered with Memorial Health's pediatric services in Gulfport.

UMMC said exceptions are normally made for patients who need emergency medical care or established patients who need continuation of care for an ongoing illness.

Failure to reach an agreement also would not affect members of the State and School Employees' Health Insurance Plan and their covered dependents, since that plan is administered by, but not offered by, BCBSMS.

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