Tri-Lakes CEO explains insurance controversy 9/10/2013

Published 12:00 am Tuesday, September 10, 2013

Tri-Lakes CEO explains insurance controversy

By Rupert Howell

Tri-Lakes Medical Center CEO Wes Sigler informed Panola supervisors that county employees were no longer, “in network, technically,” through their county- provided Blue Cross/Blue Shield of Mississippi policies as of September 1.

“If people choose to use us (Tri-Lakes), we’re going to process the claim as if it was in-network,” he assured supervisors.

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When a provider (physician or hospital) is “out-of-network” the insurer might reimburse the provider a lesser amount for patient services than for those who are “in-network,” which can mean higher out-of-pocket expenses for the patient, according to Tri-Lakes Web site.
The Web site also states that it is their commitment to their BCBS of MS patients that they will do what is within their power not to penalize patients for the termination decision made by BCBS of MS.

The county, with a state-wde organization, is self-insured with Blue Cross/Blue Shield as the administrator. Statewide employees who have Blue Cross are not affected.

Sigler said his company, HMA, was receiving less from the patient and less from Blue Cross and taking a financial hit adding, “We’re trying to make it so it does not have an impact (on patient’s cost),” Sigler added.

“They (Blue Cross) are basically saying, ‘The state of Mississippi would be better off without HMA.’”

HMA currently owns 10 Mississippi hospitals admitting 10 percent of Mississippi’s patients Sigler said and noted that the state’s only burn unit was owned by HMA.

Sigler said the company was excluded from the system following HMA’s lawsuit against Blue Cross over millions of dollars HMA says it is owed by Blue Cross.

Sigler explained that his company had been willing to “stay” the lawsuit for 60 days while an understanding could be reached but that Blue Cross has cut off all mediation and communication.

Efforts by the insurance commissioner and governor to broker a meeting were also unsuccessful, Sigler told supervisors.

Some companies have directed Blue Cross to pay in all HMA facilities including TVEPA who belongs to a network of rural power cooperatives.

A representative of Tri-Lakes will be on hand when insurance representatives meet with county employees prior to October 1.

A joint legislative hearing of the Mississippi House and Senate to look into the matter is scheduled for September 16, according to Sigler.