UMMC and BCBS of Mississippi in a contractual deadlock - WLOX.com - The News for South Mississippi

UMMC and BCBS of Mississippi in a contractual deadlock

Source: UMMC Source: UMMC
Source: BlueCross BlueShield Source: BlueCross BlueShield
JACKSON, MS (Mississippi News Now) -

The University of Mississippi Medical Center has until Saturday at midnight to decide whether or not it is going to renew its contract with Blue Cross and Blue Shield of Mississippi, the state's largest healthcare provider.

However, after speaking with representatives from both sides today it appears that they have reached a stalemate.

READ MORE: UMMC will stop accepting policies from BCBS of MS

UMMC CEO, Kevin Cook says the insurer has failed to acknowledge the role that UMMC plays as a healthcare provider and as an academic institution and are therefore at an impasse.

"As you know we are the state's only academic medical center. We provide unique resources for the state of Mississippi and we hope Blue Cross recognizes that and the way that they pay us," he said.

In an email sent to WLBT this afternoon, BCBS issued a statement, saying in part:  

UMMC continues to be unwilling to work within their existing contract and has chosen to cancel their Participating Hospital Agreements with Blue Cross & Blue Shield of Mississippi beginning July 1, 2018. We are currently in non-network transition phase, and UMMC will be a non-network facility effective midnight June 30, 2018.

This isn't the first time UMMC and Blue Cross and Blue Shield have butted heads. 

"When we were able to negotiate different rates with Blue Cross, systematically over the years they took those rates back because of the language in the base contract they were allowed to do that." Cook said. 

The current contract allows Blue Cross Blue Shield the right to change the financial terms of the contract at any time and without giving any notice to UMMC.

"None of us would agree to a contract of that type that allows one party to change the financial terms without notifying or the other party agreeing to it," Cook said. 

Which is why Cook says, the contract itself is the key issue.

"They can agree to anything but then in succeeding years take those rates right back," he said. 

WATCH: UMMC press conference on BCBSMS contract dispute PART 1

WATCH: UMMC press conference on BCBSMS contract dispute PART 2

So, what will happen if an agreement isn't made?

In the same statement, BCBS of Mississippi will continue to provide network-level benefits for medically necessary care received from UMMC, but patients coming in for elected procedures or routine doctors visits at UMMC or UMMC owned facility will be out of network, Cook added. 

The following is the full statement from Blue Cross Blue Shield of Mississippi:

UMMC continues to be unwilling to work within their existing contract and has chosen to cancel their Participating Hospital Agreements with Blue Cross & Blue Shield of Mississippi beginning July 1, 2018. We are currently in non-network transition phase, and UMMC will be a non-network facility effective midnight June 30, 2018.

As always, our members are our top priority, and we will continue to act on their behalf to ensure they have access to quality, cost-effective care when and where it is needed. Blue Cross and Blue Shield members do not need to worry about the impact of UMMC’s action on their access to care as we will continue to provide Network-level benefits for medically necessary care received from UMMC and will work with our members to coordinate their care in the most appropriate setting.

We have informed our customers and Network Providers of the upcoming change and how it may impact them, specifically:

  • All emergency care will continue to be covered at Network-level benefits.
  • Network-level benefits will be paid for members currently receiving medically necessary care, those requiring ongoing follow-up or coordinated care at UMMC, and those patients who are newly referred and approved to use UMMC as their provider of choice. Benefits may vary according to a member’s specific benefit plan.
  • At a member’s direction of payment, benefit payments will be made to UMMC with the expectation that, in accordance with Mississippi state law, UMMC will provide a payment hold harmless for our members and refrain from balance billing.

Again, we will continue working on our members’ behalf to ensure they have access to the quality care they need, and Blue Cross and Blue Shield Network Providers across Mississippi, and in surrounding states, are available to serve our members.

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