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Blue Cross files defamation lawsuit to set record straight regarding UMMC network negotiations

BCBS claims UMMC’s ad campaign is maliciously designed to injure their reputation and improperly coerce them into a new contract that benefits UMMC. 

The insurance giant, Blue Cross Blue Shield of Mississippi (BCBS), is claiming in a recent lawsuit that employees of the University of Mississippi Medical Center (UMMC) engaged in a defamatory public relations campaign against the company.

The suit comes after a very public campaign across the state on multiple online platforms and billboards that insinuates that BCBS dropped UMMC from coverage. That campaign is estimated at roughly $280,000 at this point with more ad placement buys already set.

Y’all Politics reported earlier this week that the funds being used for the UMMC ad campaing against BCBS are being paid through the hospital’s “health system revenue accounts,” or essentially patient operations.

READ MORE: Where’s the money coming from at UMMC to fund PR offensive against Blue Cross?

BCBS says in the complaint that these allegations are not true.  BCBS says that on January 28, Dr. LouAnn Woodward notified BCBS that UMMC was ending its Professional Provider Network Agreement voluntarily. This termination letter was included in the court filings.

The suit contains the following: Count 1 – Defamation, Count 2 – Civil Conspiracy, and Count 3 – Injunction.

The suit claims that UMMC chose to cancel or delay appointments, require full payment before services, deactivate approved patients from transplant lists and refuse care all on their own. BCBS claims that they would continue to pay Network level benefits for covered medical services, despite the agreement termination.

BCBS says that they have been a provider for UMMC for decades, until in 2018 the hospital terminated its Hospital Network Agreements with Blue Cross, saying it should be reimbursed at rates that were “significantly higher than comparable Network providers throughout the state.”  The two ultimately came to an agreement in 2018.

The most recent contract was set to expire in July 2021, but multiple extension requests were made by UMMC and approved by BCBS, until early 2022 when the two began to negotiate new terms.

The lawsuit outlines what then transpired:

“UMMC demanded significant, unrealistic payment increases across all hospital service areas, contending that it and its physicians, nurse practitioners and other allied providers should be paid at rates substantially higher than other Network hospitals and healthcare providers throughout the State. Blue Cross proposed reimbursement increases for certain services and offered additional reimbursements through Blue Cross’ quality program designed to improve patient outcomes. UMMC refused to accept the proposed reimbursement increases and refused to participate in the quality program offering additional increases tied to improved quality measures. Instead UMMC maintained it is entitled to a 30% overall increase year one with escalating increases thereafter annually, which would include a 50% increase for certain services.”

The lawsuit was specifically filed against three individuals: Dr. LouAnn Woodward, the Vice Chancellor for Health Affairs and Dean of the School of Medicine; Associate Vice Chancellor for Clinical Affairs Dr. Alan Jones; and Executive Director of Communications and Marketing Marc Rolph.

UMMC is not named as a defendant because Mississippi law grants it immunity for defamation committed by employees.

The suit presents specific statements made by Woodward, Jones and Rolph regarding the ongoing negotiations with BCBS. This includes comments made by Dr. Woodward after her January 28 termination letter was sent to BCBS.

Some of those statements are shown below from the filing: 

The suit outlines dozens of more statements and public campaign material, that they say are defaming and untrue, regarding the situation surrounding the network negotiations.

The defendants were also found saying, “Blue Cross is denying you uninterrupted access to [UMMC] services,” which BCBS says is not true.

BCBS added that they have informed its members that they can continue to receive treatment at UMMC for which BCBS will reimburse UMMC at Network Level benefits. However, they claim UMMC has refused to treat certain BCBS members for that Network level benefit, but not all.

Blue Cross maintains that under the No Surprises Act, when an uninsured or self-pay patient seeks care at that particular hospital, UMMC is obligated to inform the patient of the right to obtain a good faith estimate of charges. This obligation happens immediately when UMMC terminates, cancels, or delays any treatment simply on the basis that the person is self-pay or uninsured.

Additionally, BCBS says that UMMC is required to provide a good faith estimate for a member who seeks an unscheduled non-emergency treatment.

Mississippi Insurance Commissioner Mike Chaney talks about the “two stubborn Goliaths” – BCBS and UMMC – at the Neshoba County Fair this week, saying the two must negotiate and find a compromise.

You can read the full suit below.

22 180 Complaint by yallpolitics on Scribd

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