UPDATE: BlueCross reinstates Gilmore, 3 others

By Michaela Gibson Morris

Daily Journal

It’s a good first step for Gilmore Memorial Regional Medical Center and three of its affiliated hospitals to be back in the BlueCross fold, but six other hospitals and the communities they serve are still out in the cold, hospital officials said.

“There is nothing we want more than to get all 10 hospitals back in network,” said Dwayne Blaylock, the River Oaks chief executive, speaking for the Mississippi hospitals owned by Florida-based Health Management Associates. “We look forward to working with BlueCross BlueShield and hope this works But, again, I say: what about patients who need River Oaks’ neonatal ICU. What about the patients in Jackson and Natchez and Biloxi who need those hospitals? Don’t we matter, too? ’’

With encouragement from state leaders, BlueCross & BlueShield announced Monday afternoon that it was unilaterally reinstating Amory’s Gilmore along with Northwest Mississippi Regional in Clarksdale, Tri-Lakes Medical Center in Batesville and Woman’s Hospital in Flowood to in-network rates despite an ongoing dispute with its parent company.

The four hospitals are back in the BlueCross network effective immediately, according to BlueCross. The six other HMA hospitals located in the metro Jackson area, Natchez and Biloxi remain out of network.

“Blue Cross clarified with each hospital that the reinstatement offer was based on their exact prior agreement with no additional requirements,” said Meredith Virden, corporate communications manager.

BlueCross made the decision to reinstate the hospitals without a formal response from HMA with encouragement from Mississippi Insurance Commissioner Mike Chaney, Virden said.

Additionally, Gov. Phil Bryant warned in an Oct. 17 letter that he would issue an executive order restoring all 10 HMA hospitals to the BlueCross network if the problems weren’t resolved.

Last week, HMA officials said BlueCross had set extra requirements for the four hospitals to return to the network, and that all of the hospitals should be reinstated.

The dispute over reimbursement rates came to a head in June when the 10 Mississippi HMA hospitals filed suit against BlueCross, making the case that the insurer had not met its obligations under their contract. The hospital system believes BlueCross owes it $18 million.

BlueCross has maintained that charges from several of the for-profit hospital group’s facilities were out of line with rates for other Mississippi hospitals.

BlueCross moved to terminate its contract with HMA hospitals effective Sept. 1 after the lawsuit was filed.

“This is very good news for Gilmore and Amory and this area,” said state Sen. Hob Bryan, D-Amory. “My understanding is this is the offer BlueCross has been trying to make clear for several days now, and I’m pleased that the offer is now completely unambiguous.”

Bryan said a resolution between the two parties is a better path than involvement by the Legislature, which was a possibility and remains so with the status of six hospitals unresolved.

“Clearly the hospitals and Blue Cross are in a better position to work this out than the Legislature,” Bryan said.

michaela.morris@journalinc.com

  • willerz

    Blue Cross is increasingly trying to strong arm hospitals into bending to their will. If hospitals are smart, they won’t let them do it. Once they know they can extort your hospital, it will never stop. You let them get their foot in the door, pretty soon they are trying to get all the way in and run things.

    • Guest Person

      I wonder why BCBS is acting this way – don’t they know our state is setting up a health insurance exchange where people can shop and compare price and service under the AHCA?

      No wait – our state officals are blocking a health care exchange and Medicaid expansion dollars. BCBS can act pretty much how they want to and who suffers?

      • willerz

        Even with the health care exchanges, there are out of network hospitals. The exchange doesn’t change that. Expect what BCBS is doing to become the norm among insurance companies.