Mississippi Insurance Commissioner Mike Chaney sent a letter late Friday to attorneys for Blue Cross & Blue Shield of Mississippi and University of Mississippi Medical Center on behalf of Frank Dungan, the Madison resident in need of a liver transplant who was featured in recent Mississippi Today stories.
Dungan, a liver transplant candidate at UMMC with Blue Cross insurance, is currently ineligible for a transplant because of the hospital’s out-of-network status with the insurance company. UMMC went out of network on April 1 after it and Blue Cross failed to resolve a contract dispute.
Blue Cross is steering Dungan toward out-of-state transplant centers in Memphis or Birmingham, but Dungan wants to stay with UMMC, where he’s developed relationships with doctors who know his history.
Over the past month, Dungan attempted to get cost estimates from both UMMC and Blue Cross of what each party will charge and pay if he received his transplant at the hospital while it was still out of network with the insurer. He couldn’t get answers from either, so he started making calls to everyone he could think of — including officials at the Mississippi Insurance Department.
Chaney told UMMC and Blue Cross he thinks Dungan’s request is “very reasonable.”
“He simply asks that UMMC provide a good faith estimate of what his liver transplant will cost, including an estimate of what he may be looking at in terms of increased charges due to balance billing for services which may be rendered beyond June 30,” Chaney wrote in the May 13 letter. “Further, he requests that BCBSMS take the estimated charges furnished by UMMC and provide a good faith estimate of the ‘in-network rate’ reimbursement that would be provided by BCBSMS … He needs this information in order to determine whether he has sufficient savings and personal assets to cover any excess charges that may apply.”
Chaney also asked that the two parties work together to ensure he can receive a transplant without becoming financially destitute or traveling long distances for care.
“Please work together to enter a single case agreement that will shield Mr. Dungan from any excess charges above and beyond his standard cost-sharing responsibilities,” wrote Chaney. “This single case approach will allow Mr. Dungan to receive the life-saving transplant he so desperately needs without depleting his life savings and without him having to travel long distances to have the procedure done in a location where he has no family or other support group who could assist him in the recovery and healing process.”
He asked both Blue Cross and UMMC to respond to Dungan and the insurance department by Tuesday, May 17 at 10 a.m.
Dungan said a representative from UMMC called him over the weekend to provide a cost estimate for the transplant surgery if he paid completely out of pocket. The hospital is going back to create an updated estimate for the cost if insurance is involved – meaning Dungan would direct Blue Cross to pay its “network benefit” amount directly to him to then pay UMMC. Dungan would then be responsible for the balance between what UMMC charged and Blue Cross paid.
Chaney made another pointed statement at the end of the letter: He asked the lawyers to review state law that requires health insurance companies maintain a network of doctors that is “sufficient and numbers and types of participating providers to covered persons will be accessible without unreasonable delay.”
This is not the first time Chaney has raised concerns over whether Blue Cross is meeting network adequacy requirements with UMMC out of network.
Chaney referred to the “unique services” only available at UMMC in a March 3 letter to Carol Pigott, Blue Cross’ president and chief executive officer. He cited the children’s hospital, organ and tissue transplant program and Level IV neonatal intensive care unit, among other programs.
“Without the adequate availability of these specialized services in the BCBSMS Network, I believe there would be a disruption of needed health care services to consumers in Mississippi, thus potentially creating a Network Adequacy issue for BCBSMS,” the letter, which was also sent to the governor, lieutenant governor and speaker of the House of Representatives, stated.
Chaney directed Blue Cross to produce a “Network Adequacy Status Report” showing how Blue Cross will meet its statutory requirements if UMMC goes out of network.
Cayla Mangrum, manager of corporate communications, said the report was “confidential and proprietary” when Mississippi Today asked for a copy of Blue Cross’ response.
— Article credit to Kate Royals of Mississippi Today —