Chaney obliging Bryant on probe of BCBS provider adequacy

With a U.S. District judge having invalidated his executive order, Gov. Phil Bryant says he will no longer seek to force Blue Cross and Blue Shield of Mississippi to re-instate in-network status to policyholders who use the services of the 10 Mississippi hospitals owned by Health Management Associates.

But the governor still wants to get to the bottom of whether the giant insurer, which is said to control 80 percent of the health care insurance market in the state, is adhering to the state’s insurance rules and policies in its standoff with HMA over reimbursements. Insurance Commissioner Mike Chaney says he is particularly concerned about the viability of BCBS’s provider network minus HMA. He said he began investigating the issue even before Bryant had asked for it.

The Department of Insurance, he said, “is in the midst of an in-depth and vigorous investigation of the adequacy of Blue Cross’ provider network. This investigation began prior to the issuance of Executive Order 1327 by the Governor’s Office.”

Bryant also wants Chaney to hold hearings on the issue and has pledged to seek legislation in the 2014 session to resolve it “if there is no private or administrative solution to this problem.”

Chaney did not say in his email reply to a press inquiry whether hearings would follow his investigation. If he does not hold hearings, Bryant will insist on knowing the reason.

HMA sued BCBS in June on a claim the insurer owes it $19 million in additional reimbursements. BCBS reacted by severing its ties with HMA. The hospital group is continuing to treat the tens of thousands of BCBS policyholders at in-network rates but insists it can’t continue do so for much longer.

A crack recently occurred in the impasse when Blue Cross agreed to readmit four HMA hospitals –Gilmore Memorial Medical Center in Amory; Northwest Mississippi Regional Medical Center in Clarksdale; Tri-Lakes Medical Center in Batesville; and Woman’s Hospital in Flowood – to its provider network. HMA initially balked at the reinstatement, saying it did not like the terms under which BCBS made it.

Bryant said he believes he could have prevailed against BCBS’s attempt to invalidate his order had he received a hearing the full court. He noted, though, that he thinks more progress can be made on the issue outside of court.

 

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