New ruling lets NMMC extend discount to BCBS patients

By Michaela Gibson Morris

Daily Journal

TUPELO – People with BlueCross BlueShield insurance will be getting a break from North Mississippi Medical Center.

A reinterpretation of a federal Medicare rule will allow NMMC to pass on discounts to BlueCross BlueShield policyholders even though the two companies have not had a contract since Dec. 1.

“This at least will take some pressure off BlueCross BlueShield patients,” said Gerald Wages, NMMC interim CEO.

Starting today, the hospital will apply the discount it had offered BlueCross BlueShield in its original contract negotiations – 15 percent discount for inpatient services and 17 percent discount for outpatients, Wages said.

Retroactive discounts

The hospital will apply the discounts back to Dec. 1 bills, Wages said. They will be working to credit those accounts over the next 90 days and will be issuing refunds to patients who had settled their accounts in full.

If BlueCross continues to take a 20 percent discount on outpatient accounts, patients will owe 3 percent of their bill after their deductible and co-insurance, hospital officials said.

If the insurance company continues to take a 24 percent discount on inpatient accounts, patients will owe 9 percent after their deductible and co-insurance.

BlueCross BlueShield reaffirmed the way it determined allowable charges on accounts with NMMC.

“Our payment amounts are based on the reimbursements for a non-participating hospital,” said John Sewell, BlueCross BlueShield director of corporate communications. “We remain committed to a resolution that will establish reimbursements consistent with our participating hospitals across the state.”

The decision to offer the discounts to BlueCross policyholders will cost NMMC an estimated $1.2 million to cover the services from Dec. 1 through April 1, said Jane George, NMMC controller.

Federal rules

When BlueCross BlueShield signaled its intention not to renew the contract in September, hospital officials wanted to extend the discount to patients, Wages said. However, existing Medicare rules prevented them from extending discounts to individuals.

In March, Health and Humans Services Secretary Tommy Thompson announced a reinterpretation of the rules to allow hospitals to extend discounts to the uninsured and underinsured, primarily in response to issues raised in California.

“We're really pleased” to be able to pass on the discounts, Wages said.

The insurance contract dispute applies only to inpatient and outpatient services at NMMC-Tupelo. The community hospitals and medical clinics are not affected by the insurance dispute.

Even though the medical center has moved to take the financial pressure off patients, NMMC is still on the hot seat to get the contract resolved.

“We hear very clearly that the community would like to get the BlueCross BlueShield issue resolved,” Wages said. “Negotiations have been very active in the last week.”