Rejection of Blue Cross offer to reinstate 4 hospitals as in-network hardens HMA impasse
by Ted Carter
Published: October 17,2013
Blue Cross & Blue Shield of Mississippi reacted with puzzlement to Health Management Associates rejection Wednesday of the insurers’ offer to reinstate in-network provider status to four HMA hospitals.
HMA said Wednesday it could not accept terms that included pre-certification for in-patient admissions of Blue Cross policyholders. Blue Cross said it found that objection surprising since the pre-cert condition is included in all its network-provider agreements.
“Blue Cross & Blue Shield of Mississippi offered to reinstate four HMA hospitals based on the exact agreement that was in place at the time the hospital agreements were terminated,” said Blue Cross spokeswoman Meredith Virden, referring to Blue Cross’ Sept. severing of its agreement with the 10 HMA hospitals in reaction to HMA suing the insurer for an additional $19 million in provider reimbursements.
HMA’s thumbs down on the offer closed what appeared to be an opening in the impasse between the giant insurer and Naples-based HMA.
Late Monday afternoon, Blue Cross & Blue Shield of Mississippi gave notice it would reinstate network provider status starting Tuesday to Memorial Regional Medical Center in Amory; Northwest Regional Medical Center in Clarksdale, Tri-Lakes Medical Center in Batesville and Woman’s Hospital River Oaks in Flowood.
HMA’s six other Mississippi hospitals are Biloxi Regional Medical Center; Central Mississippi Medical Center, Jackson; Madison River Oaks Medical Center; River Oaks Hospital, Flowood; Crossgate River Oaks, Brandon; Natchez Community Hospital.
River Oaks Hospital CEO Dwayne Blaylock said in an Associated Press report Wednesday the insurer wanted the hospitals to agree to pre-certification of in-patient admissions, a process HMA officials said can take up to five business days, and to continue to be reimbursed at the rates at dispute in a lawsuit.
Blue Cross said its reinstatement offer clarified that only those services currently being provided at the hospitals would be considered for payment. Blue Cross & Blue Shield of Mississippi said it also clarified that pre-certification and “prior authorization for certain services would continue to be required as it was part of the hospital’s utilization management responsibility in the prior agreement. This is a responsibility of all Blue Cross & Blue Shield of Mississippi’s Network Hospitals as it is important to ensure that our members’ care is medically necessary and that high-risk care is coordinated.”
Further, in a press statement Thursday afternoon, Blue Cross said it was unfortunate that “HMA continues to misinform the public to distract from HMA’s profit motives and excessive charges.
“It is also unfortunate that instead of formally responding to Blue Cross & Blue Shield of Mississippi’s reinstatement offers to the four hospitals, HMA chose to use the offers to continue its misinformation and attack campaign.”
Thursday’s comments from Blue Cross marked a continuation of an exchange of charges from the two health care entities.
In a press statement Tuesday, HMA called Blue Cross Blue Shield’s partial concession offer an acknowledgment that “their decision to lock out 10 hospitals from their provider network was causing devastating consequences for patients, policyholders and communities.”
The hospital company has continued treating Blue Cross Blue Shield policyholders as in-network patients but says the costs make it unlikely the hospitals can continue doing that for long.
“One thing is certain: Insurance giants should not get to decide which patients and communities have access to quality healthcare,” Blaylock said.
In its announcement Monday, Blue Cross said it previously had made the offer on the four hospitals conditioned on HMA dropping its lawsuit. This time, Blue Cross is extending the offer out of its duty to show “leadership” in the dispute.
“Since HMA is not willing to take the necessary action for these hospitals that provide a unique service to their community, Blue Cross & Blue Shield of Mississippi will take the leadership role and move forward,” said Meredith Virden, manager of communications.
“As to the other HMA hospitals, significant issues regarding HMA’s charges and lack of focus on managing healthcare costs are still of great concern.”
Blue Cross said in a follow up to the press statement the offer included no deadline or time frame to respond.
The member-funded insurer emphasized that it felt the four hospitals are too valuable to their communities to be put at risk by the contractual dispute. “It is for this reason that we have moved forward with giving these hospitals the opportunity to be reinstated as Network hospitals,” Blue Cross said in an email reply.
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