By Rupert Howell

Tri-Lakes Medical Center will continue to serve Blue Cross patients and not penalize patients for decisions made by Blue Cross according to  Wes Sigler, CEO of Tri-Lakes.

Health Managment Association (HMA), owner of Tri-Lakes Medical Center said in a news release last week, “In what appears to be a retaliatory response to a recent complaint filed for underpayment for services, BlueCross Blue Shield of MS (BCBS of MS) sent ten Mississippi hospitals letters of termination.”

If Blue Cross no longer has contracts (preferred provider status), hospitals would be reimbursed at lower out-of-network rates, meaning individual patients could face much higher out-of-pocket costs according to the Mississippi Business Journal. Sigler said Tri-Lakes patients will not suffer consequences.

The letters were sent approximately 10 days after a breach of contract lawsuit was filed against Blue Cross Blue Shield of Mississippi by HMA. The suit claims BCBS of MS wrongfully reduced inpatient payments. The termination date is August 28.

Attempts to discuss the disputed underpayments have been repeatedly dismissed and ignored by BCBS of MS since the fall of 2011 according to HMA’s news release.

A lawsuit is a legal document that represents only one side of civil litigation.

HMA had sued Blue Cross for $13 million a week earlier, claiming the insurer is breaking contract terms by underpaying for a number of procedures, the news release states. 

At the same time, Blue Cross and Jackson’s University of Mississippi Medical Center continue talks over payment rates, with the possibility that the insurer will no longer contract for treatment at the state’s largest hospital. The deadline for that contract ended, but was extended and now would end Aug. 28, unless an agreement or another extension is reached.

No attempt was made to discuss terminations before – or since – the letters were sent, the news release states and continues, “Recent statements by BCBS of MS leadership attempt to place the blame for their decision on the hospitals. However, the hospitals in question haven’t had a rate increase from BCBS of MS in three years. And, as explained in the lawsuit, the insurance provider has been paying the hospitals less than what the current contract mandates.”

“Tri-Lakes Medical Center will continue serving Blue Cross patients”, Sigler said adding “We will not penalize our patients for the decisions made by Blue Cross.  We are committed to working with our patients to prevent them from taking on any additional out-of-pocket expense.”

“Our intent was to avoid any interruption of services while the courts resolved our dispute with BCBS of MS”, explained Bill Williams, Division CEO for the Mississippi area. “We continue reaching out to BCBS of MS.  It’s disappointing that they’ve chosen to place their policy holders and our patients in the middle of this situation.”

Changes would not apply to patients covered by the State and School Employees’ Health Insurance Plan. The state government is self-insured and Blue Cross only administers its plan, according to a story in Insurance Journal.

The hospitals receiving BCBS of MS termination letters are: River Oaks Hospital, Central Mississippi Medical Center, Woman’s Hospital, Madison River Oaks Medical Center, Crossgates River Oaks Hospital, Biloxi Regional Medical Center, Natchez Community Hospital, Northwest Mississippi Regional Medical Center, Tri-Lakes and Gilmore Memorial Regional Medical Center.  
Blue Cross & Blue Shield, which is owned by its policyholders, had 54 percent of the health insurance market in Mississippi in 2012, according to the American Medical Association
UMMC cares for the most inpatients in Mississippi, with about 10.7 percent of the average daily patient count statewide last year, according to state Health Department figures.

HMA’s 10 hospitals combined follow closely with 10.4 percent of the average patient count statewide, the second-largest share.