What to know after UMMC contract with Blue Cross & Blue Shield of Mississippi expires - Clarion Ledger

As of April 1, the University of Mississippi Medical Center hospital system is no longer part of the Blue Cross & Blue Shield of Mississippi network after contract negotiations fell through.

The hospital system and insurer were not able to come to an agreement over reimbursement rates for hospital services for BCBSMS members.

UMMC has treated more than 50,000 patients with a Blue Cross commercial health insurance plans over the past 18 months, according to a press release issued by the hospital system on Friday. 

That represents about 10% of the hospital system's business, not including the state employees' health plan which will not be impacted, according to Marc Rolph, UMMC executive director of communications and marketing.

The dispute will ultimately come at a cost to Blue Cross Blue Shield members who face paying higher out-of-pocket costs for medical care within the UMMC system with the exception of emergency care. 

Though UMMC said their goal is that an "updated, fair contract can be agreed upon" with the best interest of patients, patients receiving currently receiving care or treatment at UMMC for specific ongoing medical conditions will only have in-network coverage until July 1. 

More: UMMC wants more pay in contract negotiations with Blue Cross & Blue Shield of Mississippi

More: UMMC, Blue Cross Blue Shield Mississippi contract expires; some patients face higher costs

Cayla Mangrum, manager of corporate communications for BCBS of Mississippi, said however, that the insurer "is not optimistic about negotiations. Unreasonable demands by UMMC for increased payments, along with their unwillingness to agree to Hospital quality requirements, are not in the best interest of our members and groups as we seek to provide access to quality, cost-effective healthcare." 

We spoke with UMMC and BCBSMS officials to better understand how this will affect coverage for BCBSMS members who currently receive care within the UMMC system.

Will I have to get a new doctor?

Emergency services will continue to be processed as in-network. Patients undergoing active treatment and qualify under federal guidelines for continuing care may still be treated as in-network for a period of 90 days ending on July 1, 2022, according to Marc Rolph, the executive director of communications and marketing at UMMC.

BCBSMS will continue to provide network-level benefits for UMMC covered services. Members who want to get a new provider can contact the BCBSMS's Care Management Team, according to Cayla Mangrum, manager of corporate communications for BCBS of Mississippi. 

Will my old claims still get paid?

"Yes. All members' claims, prior to April 1 will be processed for network-level benefits," Mangrum said.

Which BCBS plans are impacted?

The expiration of the contract affects all BCBS network benefit plans including BCBS plans from other states and the federal BCBS plan. It does not, however, impact the state health plan and the Mississippi State and School Employees Plan, Rolph said. 

Where can BCBS Mississippi customers find a provider, and address benefit questions following the contract expiration?

If a member needs care for preventive or elective services or would like to be referred to a Network provider, they should contact our dedicated Customer Team at 1-800-898-7797.

Mangrum said that members who receive any services at UMMC should understand their rights to instruct BCBSMS on where to send benefit payments. Members should provide Blue Cross & Blue Shield of Mississippi with the direction of payment instructions to make the network-level benefit payment for covered services to UMMC. UMMC should accept the benefit payment and not bill the member for any amount other than any deductible and coinsurance/copay.

She added that members asked to pay upfront in full for services or have trouble scheduling an appointment should contact the BCBS customer service team at 1-800-898-7797.

Updated information for BCBS commercial plan members in Mississippi is available at: https://www.ummccares.com/.

Maria Clark is a general assignment reporter with The American South. Story ideas, tips, questions? Email her at mclark@gannett.com or follow her on Twitter @MariaPClark1. Sign up for The American South newsletter. Follow us on Instagram, Facebook and Twitter.