Hospitals Ask Blue Cross to Live Up to Press Release

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.

“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. “

Dwayne Blaylock, CEO of River Oaks Hospital, one of six hospitals Blue Cross did not offer to restore network status to, questioned why Blue Cross was choosing some hospitals but ignoring patients and policy holders who needed access to others.

“Every hospital is unique. At River Oaks, we are proud to have one of the top Neonatal Intensive Care Units in the region. I want to ask Blue Cross why they won’t put my hospital back in network so mothers and babies from around Mississippi can have access to this top quality care?’’ he said. “On behalf of the other hospitals in Biloxi, in Jackson, in Brandon, in Madison, and in Natchez – I want to ask Blue Cross — don’t our patients matter? Don’t your policy holders in these communities matter?”

Chris Glick, M.D., a Neonatologist who led the effort to establish the premier ICU at River Oaks, warned that excluding River Oaks from networks has the potential to have devastating consequences.

“Blue Cross is interfering with my ability to take good care of my patients. As a neonatologist, I deal with the tiniest of patients. River Oaks offers a unique program to provide the specialized care needed for these babies. Blue Cross is telling me to send my babies to other hospitals that don’t have these services and is thereby jeopardizing the health and well being of mothers and babies in Mississippi. River Oaks and the other hospitals should be put back in network immediately.”

Flowood Mayor Gary Rhoads criticized the insurance giant for trying to decide which hospitals matter.

“Patients and communities were already scared and confused as a result of Blue Cross’ decision to kick ten hospitals out of their network. Now, folks are getting mad at Blue Cross. For them to cherry pick four of the ten hospitals as able to go back into network is outrageous. An insurance company is not supposed to tell premium paying policyholders what doctor or hospital they have to see when they are sick. I can sure understand why people are so angry at Blue Cross.”

Joe Bailey, M.D., of Amory, has been a vocal critic of Blue Cross for using its decades of non-profit status to build overwhelming control of market share and the switching to for-profit status and start bullying providers into submission.

“As much as everyone in Amory wants Gilmore Memorial Hospital back in the Blue Cross network, we should not accept the offer that is full of conditions that would make access to patient care more difficult,’’ said Bailey. “We only have one hospital in Amory and Blue Cross is continuing to put it at risk. This is easy to fix – just put all ten hospitals back in the network and let the two companies deal with their disputes privately or in court.”

Blue Cross officials stated publically 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% 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.’