Blue Cross, UMMC resolution moving at a ‘snail’s pace,’ insurance commissioner says

by Kate Royals, Mississippi Today
June 7, 2022

A resolution to the dispute between the state’s largest insurer and hospital is off to a slow start.

Insurance Commissioner Mike Chaney said mediation between Blue Cross & Blue Shield of Mississippi and the University of Mississippi Medical Center has begun but is moving at a “snail’s pace” so far.

“Some preliminary groundwork has been set,” he said. “… I expect by Monday of next week, it’ll ramp up to full steam.” 

While Chaney does not have authority to force the two parties to agree, he made a pointed statement: “I do have the authority to make them mediate. If either party tries to forestall or hinder mediation, they run the risk of damaging the University (of Mississippi) Medical Center possibly beyond repair. And they run the risk of damaging the health insurance side.” 

Marc Rolph, Executive Director of Communications and Marketing at UMMC, told Mississippi Today that actual mediation will begin next week.

Blue Cross officials said they could not comment on mediation because it was confidential.

Meanwhile, patients are still in the lurch. Frank Dungan of Madison is on the transplant list for a liver at UMMC. But because the hospital is out of network with his insurer, he has been marked “inactive” on the list. 

In mid-May, Chaney asked both Blue Cross & Blue Shield of Mississippi and the University of Mississippi Medical Center to provide a cost estimate for what a liver transplant would cost Dungan while the hospital is out of network with his insurer. 

Despite the insurance company directing him to go out of state and enroll in another transplant program. Dungan said he asked for his doctor to refer him to one of those transplant programs out of state, but the program never responded.   

Dungan wants to stay at UMMC, where he has years-long relationships with his doctors. He wanted to know what it would cost him to stay there and get the procedure – but he was having no luck getting any numbers from either UMMC or Blue Cross. 

After Chaney sent the letter, UMMC provided a cost estimate for the surgery to Dungan and Chaney, and representatives for Blue Cross provided an amount to Chaney. Both asked Dungan to keep the numbers confidential, he said, but he would have had to pay a significant amount to make up the difference in what the insurance company was willing to pay and what UMMC would charge. 

There were further conversations between the two, Dungan said, but he never received anything in writing. He’s also been unable to get any cost estimates of what the immunosuppressants post-surgery would cost. 

Two weeks after the communication from Blue Cross and UMMC, he’s dealing with additional medical problems. 

Dungan’s knees locked up and began swelling. He couldn’t walk, which led him to the emergency room and later received injections of steroids. Now, he’s trying to figure out whether he’ll need surgery before he’s able to get a transplant. 

He also discovered he again has an esophageal condition caused directly by his liver disease. The condition requires a procedure.

He’s frustrated that he’s having to see a provider outside of UMMC for his issues.

“It makes it more difficult, it makes it more complex for me to schedule and keep up with my health care appointments,” he said. “I’m sure they’re doing the best they can to communicate, but it’s two different systems.”

Chaney’s office is continuing to hear from Mississippians with questions about the dispute – including those who receive care that can only be found at UMMC – and what it means for their medical care. 

Chaney said he is trying to work with individuals on a case-by-case basis, particularly those who use Children’s of Mississippi or who are on the organ transplant list. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.