Update: Response from BlueCross below
By Michaela Gibson Morris
AMORY – In the face of being locked out of the BlueCross BlueShield network, Gilmore Memorial Regional Medical Center will host a community town hall rally today.
“This is a patient access issue,” said Gilmore chief executive Allen Tyre in a Wednesday meeting with the Daily Journal editorial board. “People’s lives are at stake.”
The rally will be at 1:30 p.m. today in the Women’s Center’s main entrance lobby in Amory.
In June, the 10 Mississippi hospitals owned by Health Management Associates, including Gilmore Regional, filed suit against BlueCrossBlueShield, making the case that the insurer had not met its obligations under their contract. The hospital system believes BlueCross owes them $18 million.
BlueCross countered that the for-profit hospital system’s reimbursement rates were too high and notified the 10 hospitals they would no longer be a part of the insurer’s network effective Sept. 1. The insurer has shown no interest in ending the stalemate.
“We don’t know their demands,” Tyre said. “They won’t meet with us.”
In a statement, BlueCross reiterated its commitment to making sure its members have access to healthcare and help managing the costs.
“The facts are that HMA area hospitals charge their patients significantly more than other area Network Hospitals charge their patients – in some cases more than double the charges,” according to a statement provided by BlueCross corporate communications manager Meredith Virden. “HMA’s allegations that Blue Cross & Blue Shield of Mississippi has refused to try and resolve this contract issue is false. Blue Cross has advised HMA numerous times that it is willing to re-contract with some HMA hospitals if HMA would permanently dismiss its baseless lawsuit. HMA has refused.”
Most of the affected hospitals are in communities where BlueCross subscribers have access to other hospitals – Natchez, Jackson and Biloxi. But in communities like Amory, Batesville and Clarksdale, the BlueCross action takes the only hospital out of network.
“They have an obligation beyond a normal insurer,” said state Sen. Hob Bryan, D-Amory, noting that BlueCross began as a non-profit and existed for years under special state legislation.
BlueCross, the state’s largest commercial carrier, has had other well-publicized fights over reimbursement rates. A decade ago, North Mississippi Health Services hospitals went for more than a year without a contract. This August, BlueCross resolved a dispute with University of Mississippi Medical Center.
Emergency procedures continue to be covered at network level benefits for any hospital, according to BlueCross. It is for elective procedures that out-of-network reimbursement levels kick in.
Currently, Gilmore is honoring out-of-network patients by accepting what they would have paid at an in-network facility. The hospital knows it will receive substantially smaller reimbursements from BlueCross, but it isn’t clear yet how much smaller.
Since Sept. 1, the hospital is seeing about 30 percent fewer BlueCross patients than it would expect.
If the dispute continues long term, the hospital would be forced to reduce services and staff, which would have an major impact on the health and economy of Amory and Monroe County.
“The downstream ramifications for our community are huge,” Tyre said. “We can’t continue to absorb the costs indefinitely.”