Insurance executive Mike Chaney says UMMC is violating state law in the BCBS dispute

Insurance Commissioner Mike Chaney says he believes the University of Mississippi Medical Center (UMMC) is violating state law by removing patients from the state’s only health insurance facility.

The state insurance department, according to Chaney, has received many complaints from UMMC patients who were told by their doctors that they cannot receive treatment at the hospital because they are insured by Blue Cross & Blue Shield of Mississippi.

UMMC has been out of network with Blue Cross, the state’s largest insurer, since April 1 due to disagreements over reimbursement rates and Blue Cross’ care plan.

Chaney said he believes UMMC turning over patients violates Mississippi Code 37-115-31, which states UMMC “shall be used to serve the people of Mississippi in general.”

“If you’re a university hospital, you have a responsibility to take care of the people of Mississippi by law,” Chaney said.

Chaney said his office has forwarded most of the information to UMMC and “other municipalities that may be able to implement the law.”

Under federal law, public hospitals such as UMMC cannot deny patients care based on ability to pay or who provides insurance. UMMC and Blue Cross are still honoring out-of-pocket costs for Blue Cross patients who come to UMMC’s emergency room. Mississippi Today has not independently verified any instances of UMMC expelling a patient in an emergency.

UMMC’s policy is for each Blue Cross customer to sign a form that confirms that the patient knows that UMMC will not accept payment from Blue Cross for any selected service and that they will be responsible for their medical bills if they continue their care at the hospital. . With Chaney’s comments, it’s unclear whether the policy is followed by every Blue Cross patient.

“The problem is that the people at the top that we meet (at UMMC) are telling us one thing when what’s happening on the ground is completely different from what they’re telling us,” Chaney said.

UMMC spokesman Marc Rolph said the hospital has “no comment” on Chaney’s claims that UMMC is violating state law.

Federal law required UMMC to continue to honor in-network rates for some patients for a 90-day period after they left the network, but the “continuity of care” grace period ended on July 1. Since then, children with rare genetic disorders and Patients who were placed were forced to take care of the government or switch to another insurance.

Chaney also said that without UMMC in its network, Blue Cross is violating network requirements. There is a list of unique services that UMMC offers, such as the pediatric cancer care program and development programs, that cannot be found anywhere else in the state. State law requires that Blue Cross customers have access to these services if the services are covered by their insurance.

Chaney launched a comprehensive review of Blue Cross’s network on July 1, the results of which may not be completed or made public for months.

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