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UMMC goes out of network with BCBS, impacting thousands

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UMMC goes out-of-network with Blue Cross Blue Shield

Mississippi’s largest hospital went out of network with the ‘s largest insurer on Friday, meaning thousands of Mississippians will now face higher out-of-pocket costs for their care or be forced to leave the state for certain specialty care.

This is the first time the state’s only academic medical center has officially gone out of network and not had an active contract with Blue Cross Blue Shield of Mississippi, according to UMMC officials’ knowledge. 

Even though representatives for both sides have been meeting in person each week since January, the two entities were not able to agree to a new contract before the March 31 deadline. 

UMMC is asking Blue Cross for substantial increases to inpatient, outpatient and professional reimbursement rates, some as large as 50%. UMMC maintains it’s asking for below market rates for academic medical centers, while Blue Cross officials say that steep rate hikes would necessitate a substantial increase in customer premiums.

โ€œWe are disappointed that Blue Cross doesn’t value the Medical Center enough to agree to a fair contract and keep us in its network,โ€ Dr. LouAnn Woodward, vice chancellor for health affairs and dean of the UMMC School of Medicine, said in a press release. โ€œWe know that patients are disheartened and frustrated. We must โ€“ for the health and wellness of all โ€“ stand firm in our resolve that Blue Cross should agree to pay us at fair market rates.โ€

The two sides have also sparred over Blue Cross’ quality care plan, which measures hospital performance and whether services provided to patients are adequate across 15 different categories. UMMC leadership has said that the complexity involved in the care the hospital provides means it should have an individualized quality care program, while Blue Cross maintains that UMMC should be held to the same standards as its other network providers. 

โ€œIt is unfortunate we have not been able to reach an agreement,โ€ said Cayla Mangrum, corporate communications at BCBSMS, in a statement. โ€œUnreasonable demands by UMMC for increased payments, along with their unwillingness to agree to Network Hospital quality requirements, are not in the best interest of our Members and Groups as we seek to access to quality, cost-effective . We will continue to work to reach an agreement with UMMC, but until then, our primary goal remains our Members’ health.โ€

There are certain services and facilities UMMC has that cannot be found anywhere else in the state. These include Mississippi’s only Level 1 trauma center, Level IV neonatal intensive care unit and ‘s hospital, among other critical care services.

Insurance Commissioner Mike Chaney told Mississippi Today this week that he questions whether BCBS could meet the state’s Managed Care Plan Network Adequacy Regulation without UMMC in its network. The regulation requires health insurance providers to โ€œmaintain a network that is sufficient in numbers and types of participating providers to assure that all devices to covered persons will be accessible without reasonable delay.โ€

Cheney also said his office would get involved if the two parties didn’t strike a deal by Friday. 

This week, Mississippi Today spoke to parents whose children have been receiving specialty care at Children’s of Mississippi. Few have received answers about what the future and some are scrambling to find an alternative provider for their children. 

โ€œThe truth is we can’t go anywhere else,โ€ said Lanier Craft, whose son has Pompe disease, a rare genetic condition that affects the muscles. โ€œThis is all there is for us. Batson has been there since I walked in the door in February eight years ago with my child. They have done everything for us, and to just completely lose that within a day because of an agreement over money is unimaginable.โ€

There are three groups of Blue Cross Blue Shield customers that UMMC’s out-of-network status won’t apply to:

  1. Those enrolled in the Mississippi State and School Employees’ Health Insurance Plan. Though that plan is administered through BCBS, only commercial insurance plans are affected. 
  2. Patients who into UMMC’s emergency room or are transferred from another hospital. 
  3. Patients for which UMMC has a continuity of care obligation. UMMC can’t stop caring 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. For these patients, this period of coverage will expire 90 days from April 1.

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

Mississippi News

Danver’s celebrates forty seven years of continued success

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www.wcbi.com – Allie Martin – 2024-11-01 19:01:00

SUMMARY: Danver’s restaurant in , Mississippi, recently celebrated its 47th anniversary, maintaining a loyal customer base since its opening in 1977. General Larry Wade, who started as a cook, emphasized the restaurant’s focus on consistency, quality, and customer service. Despite economic challenges, Danver’s has thrived due to its enduring values and community connections, which patrons appreciate. Regular customers, like Tom Robinson, value the reasonable prices and consistent quality. The restaurant aims to continue this legacy, looking forward to its 50th anniversary in three years as it remains a cherished community staple.

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Mississippi News

Creator Studio at MUW expands opportunities for students

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www.wcbi.com – Grace Brister – 2024-11-01 18:57:00

SUMMARY: The new Creator Studio at the Mississippi for Women aims to enhance student creativity by providing a dedicated for production, podcasting, and audio work. Located in Fant Memorial Library, the studio offers essential equipment and software, lighting, microphones, and green screens. Dr. Bary Smith emphasizes that it enables from various majors to bring their ideas to without the burden of investing in expensive gear. Students can reserve the studio for projects, fostering valuable skills applicable across industries, particularly in effective communication and branding. Reservations can be made online or through the library.

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Mississippi News

New month same temperatures

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www.wcbi.com – Ashleigh Bryant – 2024-11-01 17:33:00

SUMMARY: COLUMBUS, Mississippi will experience a return to warmer weather after a brief dip, with highs in the 80s over the next few days. Friday night will be humid, dropping to the low 60s, with possible patchy fog. Saturday will be mostly cloudy but rain chances are reduced, while Sunday will see a mix of clouds and sunshine, with lows in the 60s. Next starts dry with temperatures in the upper 70s to middle 80s; however, scattered showers are possible on Election Day Tuesday, so should prepare with rain gear.

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