MS Today: “But after all that work and waiting, he, along with all Mississippians with Blue Cross & Blue Shield insurance who are on the transplant list at the University of Mississippi Medical Center, is now ineligible to receive an organ as long as the hospital is out of network with the insurer.
UMMC, the state’s largest hospital and only academic medical center, went out of network on April 1 with Blue Cross & Blue Shield of Mississippi, the state’s largest insurer. UMMC asked for higher reimbursement rates for its services and disagreed with the company’s quality care plan, which measures hospital performance and whether services provided to patients are adequate.
Mississippi has the lowest reimbursement rate from commercial insurance companies for inpatient services in the nation, according to a 2021 white paper by the actuarial and consulting firm Milliman. The outpatient reimbursement rates are also low compared to the rest of the country.
Blue Cross balked at the hospital’s proposal, and tens of thousands of Mississippians were left to face higher out-of-pocket medical expenses or find care elsewhere. UMMC has the state’s only organ transplant center in addition to the only children’s hospital, Level I trauma center, Level IV neonatal intensive care unit and other advanced specialties.
Adults and children with Blue Cross insurance represent about 10% of the transplants done each year, according to UMMC officials. They are not considered under the “continuity of care” obligation, which requires the hospital to honor in-network insurance rates for certain patients until June 30. UMMC officials say this is because a transplant recipient’s care extends far beyond 90 days and requires a lifelong prescription of expensive immunosuppressant drugs.
“We’re still looking at the legal issues and the authority we have to try and bring a settlement about between the parties,” said Mike Chaney, the state commissioner of insurance, when asked about the dispute’s impact on organ transplant candidates.”