BY MICHAELA GIBSON MORRIS
TUPELO -For the second time in a year, a BlueCross BlueShield insurer is cutting ties with North Mississippi Medical Center-Tupelo.
After Sept. 30, NMMC-Tupelo will no longer be a part of the preferred provider network for BlueCross BlueShield of Alabama, apparently because of national BlueCross rules. NMMC-Hamilton will not be affected by the change.
The change could force West Alabama residents to drive twice as far to receive specialized care, said David Graham, executive director of the Community Development Foundation in Hamilton, Ala.
“It could substantially impact people financially,” Graham said. “I'm certain they're going to be very agitated.”
The Alabama organization had not been a part of the discount rate disagreement between NMMC and BlueCross BlueShield of Mississippi.
“We've had a good relationship with BlueCross BlueShield of Alabama for years,” said Gerald Wages, NMMC system chief operating officer. “We haven't had any disagreement with them.”
The Mississippi insurer canceled its agreement with NMMC Nov. 30, 2003 after years of negotiation. Despite a year of talks, there has been no agreement to restore their contract.
“We're continuing to talk to them at least weekly, sometimes daily, but so far there's been no progress,” Wages said.
It's hard to say exactly what impact the loss of the Mississippi insurer's contract has been on the hospital, Wages said.
“Our volume has continued to grow,” Wages said. “But it's still important to get it resolved.”
Dear NMMC' Letter
In a letter to NMMC officials, the Alabama insurer cited national association rules as its reason for terminating the contract. According to the letter, state associations are not allowed to have agreements with out-of-state hospitals unless they are located in a county bordering the state line.
“The letter doesn't indicate any disagreement between BlueCross BlueShield of Alabama and North Mississippi Medical Center,” Wages said.
The letter said the issue was brought to the national association's attention and the association is requiring the Alabama organization's compliance.
The preferred provider agreement has been in force for nearly a decade without apparent conflict. BlueCross BlueShield of Alabama had contracted with NMMC after numerous requests from West Alabama patients in the mid-1990s, Wages said.
BlueCross BlueShield of Alabama did not return calls fromt the Daily Journal seeking comment.
The BlueCross BlueShield of Alabama patients make up a very small percentage of NMMC's customers, but having an open door financially for those patients is important to the mission of the hospital, Wages said.
For residents in Hamiliton, having access to the NMMC meant an easy transfer from the local hospital and a much easier drive compared to seeking care in Birmingham.
“You've pretty much isolated this local hospital from the services of the larger system,” through financial means, Graham said.
Softening the blow
The hospital will continue to treat all patients who come through their doors, regardless of insurer, and NMMC will still file insurance with the Alabama insurer, Wages said.
For those who are already in a course of treatment – such as prenatal care or cancer treatment, NMMC will not charge patients for the difference in reimbursements from BlueCross, Wages said.
Additionally, the hospital will offer BlueCross customers the same discounts that it offered the insurer, typically 15 percent for inpatient services and 17 percent for outpatient.
Even with the discount, BlueCross BlueShield of Alabama customers likely will carry a heavier load if they chose to continue to come to Tupelo.
Typically, insurers pay a lower percentage of the cost for non-emergency visits to out-of-network hospitals than to hospitals in the preferred provider network. Patients are responsible for the difference.