“We interpreted that to mean that that was their way of saying, fine, you don't want to play by our rules, you're out,” said Kace Ragan, an HMA spokeswoman in Mississippi.
Ragan said the reinstatement comes with a number of restrictions that don't apply to other hospitals. For example, patients must go through a five- or six-day precertification process before treatment.
“They offered us something that wasn't at all an offer,” she said. “We would love to be reinstated.”
In a news release, however, BCBS said the reinstatement was “based on the exact agreement that was in place at the time the hospital agreements were terminated” and not contingent on having the lawsuit dismissed. It added that restrictions like prior authorization are part of its efforts to coordinate high-risk care.
BCBS also contends that HMA's hospitals charge “significantly more” than other hospitals in its network—in some cases, more than double, according to Meredith Virden, a spokeswoman. “HMA sued Blue Cross because it wants to be paid more, not because it wants to charge patients less,” she said.
BCBS holds about 81% of the commercial market in Mississippi, according to Ragan, but the impact of the coverage termination varies by hospital. At some facilities, as many as 30% to 35% of patients might have BCBS, while in others, it's only 5% to 6%.
But for many of those patients, “this is a serious issue,” Ragan said, because HMA's hospital might be the only one in that market.
HMA's hospitals in Mississippi are Central Mississippi Medical Center in Jackson; Crossgates River Oaks Hospital, Brandon; Madison River Oaks Medical Center, Canton; River Oaks Hospital and Woman's Hospital, both in Flowood; Biloxi Regional Medical Center; Gilmore Memorial Medical Center, Amory; Natchez Community Hospital; Northwest Mississippi Regional Medical Center, Clarksdale; and Tri-Lakes Medical Center, Batesville.
Follow Beth Kutscher on Twitter: @MHbkutscher
