Have Blue Cross Blue Shield insurance? This is what UMMC going out of network means for you.

by Will Stribling, Mississippi Today
April 5, 2022

For the first time in state history, University of Mississippi Medical Center, the state’s largest hospital, has gone out-of-network with Blue Cross & Blue Shield of Mississippi, the state’s largest insurer. 

So now what?

Who is exempt from the change

There are three groups of people that UMMC’s out-of-network status does not apply to, or will receive in-network benefits for a few extra months:

1. Those enrolled in the Mississippi State and School Employees’ Health Insurance Plan will not be affected. Though that plan is administered through BCBS, the current dispute only affects the insurer’s commercial insurance plans.
2. Patients who come into UMMC’s emergency room or are transferred from another hospital will still have their current reimbursement rates honored. 
3. Patients for which UMMC has a continuity of care obligation. UMMC can’t stop honoring in-network rates for, say, a pregnant woman in her last trimester of pregnancy or a cancer patient who is in round two of 12 rounds of chemotherapy. In those cases, their Blue Cross reimbursement will be accepted. For these patients, this period of coverage will expire 90 days from April 1. 

What this means for non-emergency care

Blue Cross & Blue Shield of Mississippi has informed its customers that the insurer will continue to provide network benefits to UMMC patients – meaning BCBS is still offering to pay the in-network rate for a patient’s care. 

However, this will not prevent UMMC patients from paying highly inflated out-of-pocket costs for non-emergency care.

Blue Cross has instructed its customers to provide them with written direction to make benefit payments to UMMC. If UMMC were to accept payment from BCBS in this situation, UMMC could not bill patients for the difference between the reimbursement and cost of the service due to a 2013 Mississippi law that banned balance billing. 

However, UMMC maintains that they will not accept payments from BCBS. 

“If we were to do that (accept the payment from BCBS), then they would be able to pay us whatever they wanted in perpetuity, and we wouldn’t be able to do anything about it,” Dr. Alan Jones, UMMC associate vice chancellor for clinical affairs, told Mississippi Today in March.

Blue Cross & Blue Shield of Mississippi believes the hospital is legally required to accept its payment or consider the services as paid in full – an interpretation with which both UMMC and Mississippi Insurance Commissioner Mike Chaney disagree.

“Blue Cross & Blue Shield of Mississippi Members may direct us to pay UMMC directly for services it rendered.  Blue Cross & Blue Shield of Mississippi (BCBSMS) is required to honor the direction of payment, and UMMC is required to accept BCBSMS’ payment as payment in full for covered services and even if UMMC rejects BCBSMS’ payment, the statute provides ‘that payment shall be considered payment in full to the provider, who may not bill or collect from the insured any amount above that payment [other than deductible and coinsurance/copay]….,” Cayla Mangrum, manager of corporate communications for the company, said in a statement to Mississippi Today last week. 

“UMMC’s stated intention to refuse to accept payment directly from Blue Cross & Blue Shield of Mississippi when a Member has directed us to pay UMMC is not in compliance with the consumer protection statute and would deprive our Members of a right they are clearly provided under Mississippi law,” she said.

Chaney weighed in on this interpretation: “There’s nothing in the code section that requires UMMC to accept payment from BCBS.”

Marc Rolph, executive director of communications and marketing for the hospital, echoed Chaney.

“UMMC does not believe that an insurance company has the unilateral right to dictate the business practices of a health care provider,” said Rolph.

According to UMMC, patients will instead have to file any claims directly with BCBS and pay the UMMC bill themselves. The reimbursement a patient will receive directly from BCBS will be less than their UMMC bill. 

UMMC has said it will offer BCBS patients a discounted rate on the care they receive, but even with this discount, their care will still cost significantly more than if BCBS was still in-network.

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