Mississippi to review BCBS' network adequacy amid contract fallout with UMMC

A 90-day grace period for in-network care coverage expired July 1 between Blue Cross and Blue Shield of Mississippi and the University of Mississippi Medical Center, leading the state's insurance commissioner to announce a targeted market conduct examination of the payer, according to Mississippi Today.

The two parties first notified patients about contract renegotiations in early February over reimbursement rates. By April 1, Jackson-based UMMC was out of network with the state's largest payer. By the end of April and at the behest of Commissioner Mike Chaney, the two parties agreed to mediation to resolve the dispute, which is still ongoing.

Mr. Chaney sent a letter to BCBS July 1 to inform the payer that the state would be conducting the examination to find out if the company is following state network adequacy regulations.

"This is a stark reminder that the only ones impacted by the dispute are the consumers," Mr. Chaney wrote. "As your Insurance Commissioner, I am doing everything I can to ensure that individuals continue to have access to the healthcare provider of their choice with minimal disruption."

Mississippi law requires payers to provide reasonable access to care included in member's policies. UMMC is the state's safety-net hospital and singular provider of many services, raising concerns that BCBS is not meeting network adequacy requirements and leaving patients with few to no options for covered care.

Mr. Chaney specified eight services of concern in his letter:

  • Those provided at Blaire E. Batson Children's Hospital
  • Level 4 neonatal intensive care unit
  • Pediatric and adult congenital heart programs
  • Children's cancer care program
  • Sickle cell anemia program
  • Heart, kidney, liver and pancreas transplant program
  • UMMC's relationship with Methodist Rehabilitation Center
  • UMMC's satellite facilities

The process to appoint an examiner for the review is ongoing. Though a final report is expected to take months, any violations that are found could lead to the payer having its state license to operate revoked, a fine of up to $5,000 per violation, or both.


Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Learning Opportunities

Featured Webinars

Featured Whitepapers

Featured Podcast

Top 40 articles from the past 6 months