Blue Cross and UMMC settle rate differences

Blue Cross and Blue Shield of Mississippi and the University of Mississippi Medical Center have reached a one-year agreement over rates the insurer will pay.

UMMC and Blue Cross officials signed the agreement Monday, ending six months of negotiations.

With the agreement in place, patients insured through Blue Cross can continue to receive in-network care at UMMC. The existing contract was set to expire Aug. 28.

If the two parties had not agreed, UMMC would have been reimbursed at lower out-of-network rates, meaning patients would have faced higher out-of-pocket costs.

“We’re glad that we were able to come to an agreement without any disruption in coverage,” Dr. James Keeton, UMMC vice chancellor for health affairs and dean of the School of Medicine, said in a statement.

“We were very concerned about how this issue was going to impact our patients. While UMMC needs equitable reimbursement for the highly specialized services we provide, the last thing we wanted to do was to inconvenience or cause hardship for our patients.”

Dr. Tom Fenter, chief medical officer for Blue Cross, said the agreement with UMMC “will allow us to continue to manage the costs of health care for our members.”

“In this time of health care reform and the challenges of increased costs, Blue Cross & Blue Shield of Mississippi is committed to working with its network providers across the state on quality of care initiatives and cost management programs that focus on the health and wellness of Mississippians,” Fenter said in a statement.

Insurance Commissioner Mike Chaney said he was pleased the two were able to agree.

“This new agreement will allow Blue Cross to continue to partner with UMC in managing health care costs for Mississippians. It will also ensure that consumers in Mississippi and throughout the United States have continued affordable access to some of the finest medical care available from a premier medical research facility,” Chaney said in a statement.

UMMC began negotiating with Blue Cross earlier this year, seeking higher reimbursement rates. As part of that negotiation, UMMC set a termination date of June 28, which was extended twice.

Blue Cross & Blue Shield, which is owned by its policyholders, had 54 percent of the health insurance market in Mississippi in 2012, according to the American Medical Association.

UMMC cares for the most inpatients in Mississippi, with about 10.7 percent of the average daily patient count statewide in 2012, according to state Health Department figures. HMA’s 10 hospitals combined had about 10.4 percent of the average patient count statewide, the second-largest share.

Blue Cross is embroiled in another rate dispute with Naples, Fla.-based HMA, which has 10 hospitals in Mississippi. The insurer sent the termination notice to Health Management Associates hospitals statewide on June 25. HMA had sued Blue Cross for $13 million a week earlier, claiming the Flowood, Miss., insurer is breaking contract terms by underpaying for a number of procedures.

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