State’s only academic medical center, and providers, dropped from BCBS network
Published on Friday, April 1, 2022
By: Marc Rolph, mrolph@umc.edu
Editor's note: Effective Dec. 15, 2022, UMMC is back in network with Blue Cross & Blue Shield of Mississippi. Learn more.
JACKSON, Miss. – The University of Mississippi Medical Center’s contract with Blue Cross & Blue Shield of Mississippi ended at midnight March 31, meaning the state’s largest insurer has forced from its network all of UMMC’s hospitals, clinics, physicians and other providers statewide. Also impacted are members of Blue Cross commercial plans from other states and those on a Blue Cross federal plan.
Blue Cross has refused to bring the Medical Center’s reimbursement closer to fair market rates after underpaying UMMC by tens of millions of dollars per year, for many years. Blue Cross’s lack of good-faith negotiating shows it is unwilling to value the unique and vital services provided by the state’s only academic medical center and safety net hospital.
University of Mississippi Medical CenterNow, thousands of patients needing specialty care and unique services only offered in the state by UMMC will pay higher costs because they are no longer in the Blue Cross network. Over the past 18 months, UMMC has treated more than 50,000 patients who have a Blue Cross commercial health insurance plan.
Some may have to leave the state to seek services they have depended on at UMMC – for example, organ transplants or specialty care for infants and children with complex or rare diseases.
“We are disappointed that Blue Cross doesn’t value the Medical Center enough to agree to a fair contract and keep us in its network. We know that patients are disheartened and frustrated,” said Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the School of Medicine.
“We must – for the health and wellness of all Mississippians – stand firm in our resolve that Blue Cross should agree to pay us at fair market rates.”
As pulmonary respiratory therapist Kimberly Lockett directs him to breathe in and out, Jackson lung cancer patient Sammie Bass undergoes pulmonary function testing to gauge how well he can breathe.
The Mississippi State and School Employees Health Plan, which is administered by Blue Cross & Blue Shield of Mississippi, is not part of the terminated contract. UMMC is still in network for patients who have that insurance.
Patients receiving emergency care will continue to have in-network rates. Patients currently receiving care or treatment at UMMC for a specific ongoing medical condition or conditions based on federally determined qualifying criteria will continue to have in-network coverage for a temporary 90-day period, ending on July 1, 2022.
More is at stake than Mississippians’ access to specialty care and unique services.
UMMC “must have the financial ability to reinvest in the health of the state,” Woodward said. “We must have fair reimbursement so that we can provide the services, programs and facilities that patients and families need and must have, now and in the future.
Registered nurse Sarah-Kate Rowan takes the vital signs of Children's of Mississippi Urgent Care patient Jaiden Patel of Brandon as his father, Jagnesh Patel, looks on.
“Blue Cross has been unwilling to value our unique, vital services that Mississippians depend on,” she said.
Those unique services include the state’s only Level I trauma center, only children’s hospital, only organ and tissue transplant program and only Level IV neonatal intensive care unit. UMMC treats the sickest of the sick, including dozens transferred daily from hospitals that don’t have the specialty care needed for the traumatically injured and those with the gravest illnesses.
Although Blue Cross contends UMMC is no different than any other hospital in the state when it comes to reimbursement, “there are no other hospitals in the state like us,” Woodward said. “We should be compared to other safety net hospitals and academic medical centers just like us, not smaller community hospitals that just don’t care for the same types of patients we do.”
Children's of Mississippi surgeon-in-chief Dr. Ian Hoppe makes a cleft repair.
The Medical Center has asked to be funded at the level of comparable academic medical centers in regional cities such as Birmingham, Memphis or New Orleans. UMMC requested a 30% rate increase “that moves us closer to – not equal to or more than – market rates,” Woodward said.
UMMC is the state’s largest producer of specially trained health care professionals and home to the state’s emergency medical services center. It is a vital component of the state’s network of hospitals and health care providers.
Cardiologist Dr. Kellan Ashley, right, talks with patient Betty Bishop as diagnostic sonographer Karol Black performs an echocardiogram.
“Blue Cross has indicated that they don’t value us in their network and don’t need us in their network,” said Dr. Alan Jones, associate vice chancellor for clinical affairs. “The biggest impact of us going out of network is access to care that only UMMC provides to patients in the state of Mississippi.
“It’s disappointing that Blue Cross believes that it’s okay for some patients to drive out of state to get the care they need, even if doing that causes these patients financial or physical hardship.”
Updated information on how the contract’s expiration will affect patients can be found at UMMCCares.com. Patients can also call a dedicated line, 601-496-0008, with questions.