Blue Cross, UMMC agree to mediation to settle contract dispute

Blue Cross & Blue Defend of Mississippi and College of Mississippi Medical Middle have agreed to make the most of a mediation course of to settle the contract dispute that has left the state’s largest hospital out of community with its largest insurer.

The choice comes after Mississippi Insurance coverage Commissioner Mike Chaney despatched them a letter on April 21 urging them to conform to mediation. The arbitration course of entails bringing in an skilled and neutral mediator who can preside over new contract negotiations. 

Chaney advised Mississippi Right now on Thursday that he’ll be offering a number of suggestions for potential mediators by subsequent week. 

Blue Cross and UMMC used the identical mediation course of to settle their final contract dispute in 2018, and it took round ten days to strike a deal, Chaney stated. At the moment, Blue Cross agreed to take away language that made the contract evergreen, that means the insurance coverage firm may now not change the contract phrases at any time.

UMMC claims that between 2014 and 2017, Blue Cross made annual modifications to their reimbursement charges that decreased the general reimbursement UMMC obtained to look after Blue Cross sufferers.·UMMC obtained an general 1% improve as a part of the 2018 negotiations, however no modifications have been made to their reimbursement charges since then.

After the 2 events agree on who the mediator needs to be, a deadline will likely be set for them to settle their variations.  Chaney advised Mississippi Right now that the deadline will seemingly be  June 1 – 30 days earlier than the top of the 90-day “continuity of care” interval, the place sure Blue Cross sufferers can nonetheless obtain care at UMMC and have their insurance coverage accepted. 

Beneath state company guidelines, Chaney shouldn’t be allowed to straight mediate or assist settle disputes over contacts between insurance coverage corporations and well being care suppliers.

Chaney’s involvement stems from considerations that UMMC not being in Blue Cross’ community runs afoul of state community adequacy laws because of UMMC offering providers that can’t be discovered elsewhere within the state, similar to its organ transplant unit and youngsters’s hospital.

BCBSMS maintains that even with out UMMC, it’s nonetheless assembly its community adequacy requirement. BCBSMS additionally stated that the treatment in a state of affairs the place community adequacy is a matter is for it to offer community degree advantages to its clients for these providers, which it has provided to do by directing its members to signal a written course of fee instructing the insurer to pay the hospital. 

UMMC has declined to just accept these funds from BCBS, arguing that it could permit BCBSMS to proceed paying at unsustainable charges. 

UMMC and Blue Cross haven’t been in communication since April 1, when UMMC formally went out of community with the insurance coverage firm, in line with officers from each entities. Tens of hundreds of Mississippians – a few of them gravely in poor health and others in want of superior specialties solely obtainable at UMMC – are caught in the midst of the dispute.

Although the 2 events have had related contract disputes in earlier years, that is the primary time UMMC has been faraway from BCBSMS’ community. 

In consequence, tens of hundreds of Mississippians have been left to face greater out-of-pocket medical bills or discover care elsewhere. Potential transplant recipients who’ve spent months or years on organ donation waitlists have been positioned on maintain. Mother and father of youngsters who require specialised care that may solely be offered at UMMC’s youngsters’s hospital have been left with expensive and inconvenient choices for persevering with their baby’s care. 

UMMC is asking Blue Cross for substantial will increase to inpatient, outpatient {and professional} reimbursement charges, some as giant as 50%. Total reimbursement from Blue Cross would improve by round 30% within the first yr of the brand new contract. 

Mississippi has the bottom reimbursement fee from industrial insurance coverage corporations for inpatient providers within the nation, in line with a 2021 white paper by the actuarial and consulting agency Milliman. Whereas UMMC maintains that BCBSMS is paying them effectively under market charges for different tutorial medical facilities within the area, BCBSMS argues that agreeing to the will increase would necessitate vital premium will increase for his or her clients – regardless of a Mississippi Right now investigation that exposed the insurer is sitting on an infinite reserve of cash.