“We believe that such a goal is inconsistent with Blue Cross & Blue Shield of Mississippi’s goal of managing health care costs for our members. “We believe that it is the goal of HMA to maximize profits,” Blue Cross Chief Medical Officer Dr. Ragan said that under the terms of its contracts, HMA says Blue Cross will cut network coverage of its hospitals at the end of August.
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The suit, filed June 18 in Hinds County Circuit Court, seeks $13 million in damages for 20, plus interest and punitive damages.Ī week later, Blue Cross sent HMA a letter terminating contracts. Ragan said Blue Cross did not respond to HMA’s requests, and the company decided to sue the insurer. She said the company has been trying to negotiate issues surrounding what HMA sees as unilateral payment cuts that violate contracts with the company’s hospitals. HMA’s dispute with Blue Cross runs back about two years, said Kace Ragan, spokeswoman for the hospital company. Tupelo’s North Mississippi Medical Center was out-of-network from 2003 into 2005 before reaching an agreement, while Memorial Hospital at Gulfport was out-of-network for a period that included part of 1999. HMA’s 10 Mississippi facilities are Biloxi Regional Medical Center, River Oaks Hospital and Woman’s Hospital in Flowood, Crossgates River Oaks Hospital in Brandon, Madison River Oaks Medical Center in Canton, Central Mississippi Medical Center in Jackson, Natchez Community Hospital, Gilmore Regional Medical Center in Amory, Northwest Mississippi Medical Center in Clarksdale and Tri-Lakes Medical Center in Batesville.īlue Cross has had disputes with large Mississippi hospitals before. HMA’s 10 hospitals combined had about 10.4 percent of the average patient count statewide, the second-largest share. 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.
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. It’s a clash between three of the largest economic entities in Mississippi’s health care market. The state government is self-insured and Blue Cross only administers its plan. Changes would not apply to patients covered by the State and School Employees’ Health Insurance Plan. If Blue Cross no longer has contracts, hospitals would be reimbursed at lower out-of-network rates, meaning patients could face higher out-of-pocket costs. The deadline for that contract to end was Wednesday, but it was extended this week and now would end Aug. At the same time, Blue Cross and Jackson’s University of Mississippi Medical Center continue talks over payment rates, with the chance that the insurer will no longer contract for treatment at the state’s largest hospital.