Hospitals ask Blue/Cross Blue/Shield to live up to press release promises 10/18/2013

Published 12:00 am Friday, October 18, 2013

Hospitals ask Blue/Cross Blue/Shield to live up to press release promises

FLOWOOD —  Woman’s Hospital CEO Sherry Pitts on Wednesday called on Blue Cross Blue Shield of Mississippi to live up to its promise to restore Woman’s Hospital and other Mississippi hospitals back into the insurance giant’s provider network. 

Beginning September 1, Blue Cross Blue Shield of Mississippi unilaterally excluded 10 hospitals from its provider network, meaning Blue Cross health insurance policy holders face the potential of higher out-of-pocket expense or even declined reimbursement for services and procedures.  After a wave of community outrage from Biloxi to Flowood to Amory, Blue Cross Blue Shield on Monday issued a press release saying it was “offering to reinstate” four of the 10 hospitals. But the actual conditions it sent privately to the hospitals provided new conditions for reinstatement.

“We were excited when we read a press release Monday evening from Blue Cross saying they had exercised quote — “leadership” — and ended their lock-out of at least four of those 10 hospitals,’’ said Pitts.

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“We were profoundly disappointed to see that rather than do what their press release suggested, Blue Cross actually sent an entirely new proposal – a proposal with restrictions, conditions and pre-certification requirements – all of which would continue to greatly impede patient access to care:  just more red tape.’’
Requiring pre-certification for all hospital admissions, for example, undermines the very concept of a network and was not required when the hospitals were in network previously.

It would have the effect of letting the insurance provider say to the public that the hospitals were in-network but give them the power to still deny payments and claims just as they are currently doing.  Pitts called on Blue Cross to simply rescind its actions kicking the hospitals out of network.

“Let me be clear — we are prepared to say yes to the Blue Cross press release and enter an agreement that restores the contracts that were terminated,’’ she said.   “We still are. We ask them to now live up to it. Patients and Blue Cross policy holders don’t need to jump through pre-certifications and conditions when they choose our hospitals. “

Blue Cross officials stated publicly during a state legislative hearing that they took the action kicking the 10 hospitals out of network because the hospitals had disputed in a court of law Blue Cross’s adherence to the network contract. Paul Hurst, attorney for the 10 hospitals, said Blue Cross is using its 81 percent market share to send a message to any hospital in Mississippi that dares challenge them.

“Blue Cross is openly saying – `if you go to a neutral court of law because you dispute us, we will crush you,’’’ said Hurst.  “I’m proud of these hospitals for standing up to a bully and fighting back on behalf of patients and policy holders who need access to affordable care.’’