Wednesday, October 2, 2013

The BlueCross Behemoth

The next time you see BlueCross & BlueShield sponsoring some 5k race or other health-related event, you may wonder why they are constantly spending so much money to associate their brand with good health.  It could be because they don’t want you to see what they are really doing.

Health care in communities across Mississippi is facing a potential train wreck as ten hospitals find themselves locked out of BlueCross & BlueShield’s network of approved providers. It is a move by the insurance giant that will impact patients’ choices as well as their pocketbooks, and it will hit health care providers, employers, and even communities that rely on their hospitals as economic engines.

In June, BlueCross & BlueShield of Mississippi terminated the contracts for ten hospitals run by Health Management Associates, and as a result, these ten hospitals have been considered out-of-network providers since September 1.

State lawmakers held a public hearing last month. Doctors laid out for legislators some alarming consequences, such as a fundamental lack of in-patient neonatal beds at the remaining “in-network” hospitals in the Jackson-area market and the long-term harm this action is causing to hospitals in rural communities, like Amory, Mississippi, where long-time patients are being told their bills may go up or even go unpaid unless they choose a new hospital.

BlueCross says it took this action, expelling ten hospitals from network, because of an on-going dispute in civil court over past reimbursement issues, but even that excuse is alarming. Effectively, their message to these ten hospitals and to other hospitals: don’t dare disagree with us or we will build a wall between you and your patients. Never mind that our court system’s fundamental reason to exist is to be a forum to peacefully and lawfully resolve just such disputes between parties.

BlueCross may be achieving another goal here: forced consolidation of health services into fewer and fewer providers. And, with fewer choices for patients and providers, BlueCross, as the largest insurer in the state, has more and more control over health care.

So far, the hospitals have been eating the out-of-network cost so patients haven’t had to pay the difference, but even their administrative leadership said at the hearing that can’t continue indefinitely. Even with the hospitals taking a financial hit, patients are still effectively being funneled to other hospitals, putting in jeopardy the long-term future of some hospitals. And, hospitals, remember, are effectively the economic engines of many of our communities. Hospitals are a cornerstone in Governor Phil Bryant’s healthcare-based economy.

Who’s next? Interestingly, the University of Mississippi Medical Center testified at the hearing that it recently went through difficult negotiations with BlueCross before settling on a meager, one-year contract. With each hospital, the story seems to be the same: gross underpayments by BlueCross, unfair treatment by BlueCross, BlueCross’ unwillingness to negotiate, and BlueCross prioritizing their own profits before patients and the broader community.

BlueCross effectively controls the health insurance market in Mississippi. They achieved remarkable levels of market share, at least in part, because for most of the existence of the corporation was a non-profit. Today, though, it is for-profit and leveraging the market domination built over many decades to now squeeze health providers into submission.

The purpose of the legislative hearing last month was to encourage state legislators to get involved to help bring this issue to a resolution. Citizens were urged to contact legislators and BlueCross and tell them to put these hospitals back in-network and prevent BlueCross from doing this again to others.

There are some other ways citizens can stand up and fight this trend:

First, contact BlueCross & BlueShield of Mississippi and tell them you disapprove of their decision to terminate ten hospitals from network. They are dismantling an important part of that network and harming patients’ access to care across the state. You can find their contact information here.

Second, sign the petition to show your support for your hospital and its efforts to negotiate a new contract with BlueCross. BlueCross needs to hear from its members who want continued in-network access to their local hospital. You can sign the petition here.

Third, share this information with your family, friends, neighbors, and colleagues so they’re informed about what’s going on, what their options are, and what they can do to help. Our communities deserve better and can stand together to fight for what’s fair and what’s right.

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