Mississippi News
Blue Cross: Transplant candidate drops for Marketplace
In need of immediate care, liver transplant candidate drops Blue Cross for Marketplace insurance
Frank Dungan of Madison needs a liver transplant, but the focus of his past few months has not been his health. His focus has been a battle between his insurance company and his hospital that left him without insurance coverage at the state’s only organ transplant program.
But as of July 1, Dungan has switched insurers, and he’s getting the medical care he’s had to put off – and, most importantly, is back to “active” status on the transplant list.
After Dungan’s hospital, the University of Mississippi Medical Center (UMMC), went out of network with his insurer Blue Cross & Blue Shield of Mississippi on April 1, Dungan spent months trying to get answers about what that meant for him. UMMC marked him as “inactive” on their transplant list, meaning if the perfect liver match became available, he wouldn’t get a call.
Blue Cross directed him to the transplant program in Memphis, which was over three hours away from his home, a logistical and financial nightmare. He knew very little about the program, and he had spent years building relationships with his doctors at UMMC, which houses the state’s only transplant program.
Neither Blue Cross nor UMMC would get him answers about what the out-of-pocket costs would be if he got the transplant through UMMC while it was still out of network with Blue Cross. In May, Mississippi Insurance Commissioner Mike Chaney stepped in and sent a letter to both the insurer and UMMC asking they provide him with what he needs.
But Dungan said he couldn’t get definitive answers and never received anything in writing.
“It was to the point it would drive you crazy. Every time the phone rang, you were trying to figure out what other freaking problem we had,” he said.
UMMC and Blue Cross had agreed to mediation to try and settle the contract dispute, but more than two months after the hospital went out of network, a resolution still seems unlikely. Neither UMMC nor Blue Cross will speak publicly about how the negotiations are going.
The dispute stems from disagreements over reimbursement rates, with UMMC insisting Blue Cross is not fairly reimbursing the safety net hospital for its services and Blue Cross maintaining rate hikes would necessitate a substantial increase in member premiums. The hospital’s reimbursement rates are not public record.
In June, when squeezing in his appointments with various specialists before the continuity of care grace period expired for certain Blue Cross members at UMMC on July 1, one of his doctors found something concerning. He had esophageal varices, a condition that requires a medical procedure that uses elastic bands to tie off bleeding veins. If untreated, the varices can rupture and cause severe internal bleeding.
The condition commonly occurs in people with serious liver disease.
Dungan said his UMMC doctor told him the banding procedure would be “on my dime.”
Dungan was scared. He worried when going to bed each night if it would be the night he’d bleed out. He knew something had to change.
“I found a (Marketplace) insurance adviser and asked them if there were options (for me) … See, my insurance agent in my hometown had told me you can’t get health insurance except in December, even he gave me erroneous information,” said Dungan. “I was concerned about that, concerned about premiums, concerned about the language … I didn’t understand some of the language (of the policies).”
He connected with an insurance broker trained in federal Marketplace plans and found out he did not have to wait until December to sign up for a plan.
“She walked me through the specifics of the policy, and I found it covered what I needed,” he said. “She explained the deductible, the out of pocket, and the premium, everything.”
Dungan, who had an individual policy with Blue Cross, is now covered by Ambetter, which offers health care plans on the federal Marketplace and is accepted by UMMC. He underwent two procedures to address the esophageal varices earlier this month and has visited his dentist to ensure he does not have any infections in his mouth – a requirement for reclaiming his spot on the transplant list.
Switching insurances is not an option for some people, especially those whose employers only offer Blue Cross to employees.
But he’s starting from square one with his insurance: he has a new out-of-pocket limit to meet of around $8,000. But his monthly premium dropped from almost $1,200 with Blue Cross to $402 with Ambetter, he said.
“I’m back confident that I’m getting good health care and confident that my bills are not going to be outrageous,” said Dungan. “I’m confident (the UMMC doctors) are keeping an eye on me.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi News
Ole Miss women get pair of double-doubles and roll to 83-65 March Madness win over Ball State
SUMMARY: Mississippi coach Yolett McPhee-McCuin found solace in returning to a different arena in Waco, Texas, following a disappointing previous tournament experience. The No. 5 seed Ole Miss Rebels redeemed themselves with an 83-65 victory over 12th-seeded Ball State in the NCAA Tournament’s first round. Starr Jacobs led the Rebels with 18 points and 11 rebounds, while Kennedy Todd-Williams and Madison Scott each scored 15 points. Ole Miss dominated rebounding, leading 52-32, and will face fourth-seeded Baylor next. Coach McPhee-McCuin noted the team’s evolution since their last visit and the significance of playing in Texas, where Jacobs feels at home.
The post Ole Miss women get pair of double-doubles and roll to 83-65 March Madness win over Ball State appeared first on www.wjtv.com
Mississippi News
Events happening this weekend in Mississippi: March 21-23
SUMMARY: This weekend (March 21-23), Mississippi offers a range of exciting events. Highlights include Hal’s Marching MALfunction Second Line Stomp and Jessie Robinson’s blues performance in Jackson, as well as the Natchez Food & Wine Festival and the Natchez Little Theatre’s production of *This Side of Crazy*. There are also numerous exhibitions like *Of Salt and Spirit: Black Quilters in the American South* in Jackson and *Gold in the Hills* in Vicksburg. Other events include the 48th Annual Crawfish Classic Tennis Tournament in Hattiesburg, karaoke nights in Laurel, and a variety of family-friendly activities across the state.
The post Events happening this weekend in Mississippi: March 21-23 appeared first on www.wjtv.com
Mississippi News
Events happening this weekend in Mississippi: March 14-16
SUMMARY: This weekend (March 14-16) in Mississippi offers a variety of events. In Jackson, iconic saxophonist Boney James performs at the convention center, while the JXN Food & Wine festival showcases culinary talents. The LeFleur Museum District hosts a “Week of Wonder,” and several exhibitions, including “Of Salt and Spirit,” celebrate Black quilters. Natchez features the Spring Pilgrimage tours, a reenactment of Annie Stewart’s story, and a St. Patrick’s Day celebration. In Hattiesburg, comedian Rob Schneider performs, and various events like a St. Patrick’s Day pub crawl and a talent show will take place throughout the area.
The post Events happening this weekend in Mississippi: March 14-16 appeared first on www.wjtv.com
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