Bill Meredith of Sumrall was hospitalized 10 times in 2021.
In September of last year, he passed out in the shower. The next thing he knew, he woke up in a hospital bed with no clothes.
The cause of most of those visits – and loss of consciousness – was hepatic encephalopathy. Hepatic encephalopathy is a nervous system disorder brought on by severe liver disease. Meredith’s liver doesn’t properly filter toxins, and as a result, they build up in his blood and travel to his brain.
His hospitalization in December was the final straw for Meredith. He took a medical leave from his job, which he felt he could no longer adequately perform.
A doctor he was seeing in Hattiesburg referred him to the University of Mississippi Medical Center in Jackson, where he began seeing a team of specialists that helped him get the medicine he needed to decrease his frequent hospitalizations. He was put on the transplant list for a new liver on March 16.
But just two weeks later, on April 1, UMMC, which houses the state’s only organ transplant center, went out of network with Blue Cross and Blue Shield of Mississippi, Meredith’s insurance company and the state’s largest private insurer.
Meredith was paying close to $800 a month to keep his Blue Cross health insurance while on medical leave under the Consolidated Omnibus Budget Reconciliation Act, commonly known as COBRA.
When UMMC went out of network, Meredith and other transplant candidates who have Blue Cross were marked as “inactive.” The status change means the candidate stays on the list, but if his or her organ match becomes available in the time frame the hospital is out of network, the candidate won’t be getting a call.
UMMC and Blue Cross are at odds over reimbursement rates and Blue Cross’ quality care plan, which measures hospital performance and whether services provided to patients are adequate. UMMC officials say they are underpaid by Blue Cross compared to other academic medical centers in the region, while Blue Cross leaders say UMMC’s request is unreasonable and would necessitate an increase in member premiums.
The stalemate between the two has left tens of thousands of Mississippians in the lurch — particularly those who receive care at UMMC that they cannot get elsewhere in Mississippi.
Emails between officials with the Mississippi Insurance Department, UMMC and Blue Cross show failed attempts on the part of Insurance Commissioner Mike Chaney to get UMMC and Blue Cross to agree on a “single case agreement” on at least one occasion.
“As Insurance Commissioner, I have an additional request to make on Mr. (redacted) behalf. Please work to enter a single case agreement that will shield Mr. (redacted) from any excess charges above and beyond his standard cost-sharing responsibilities,” Chaney wrote to UMMC and Blue Cross attorneys on May 13. “This single case approach will allow Mr. (redacted) to receive the life-saving (redacted) 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.”
Chaney said he is not aware of any single case agreements ever being signed by either UMMC or Blue Cross, and he has not been in communication with either party about the progress of mediation since August.
UMMC declined to comment for this story. Blue Cross did not respond to Mississippi Today’s questions by publication time.
Meredith spent the first months of summer getting his long term disability insurance in place, hoping the dispute between UMMC and Blue Cross would be resolved. After the 90-day grace period that allowed certain people to continue paying in-network rates for care at UMMC expired, he began having to pay out of pocket for his appointments with UMMC doctors.
He asked one of his doctors if it would be safe to wait until his next appointment in three months to see if the two parties reach an agreement, and she said yes.
“Then as that began to draw to a close, I’m not hearing anything about where this negotiation is going,” he said, referring to the mediation the two parties began in June. “I finally gave up on that.”
In July, he decided to switch insurance companies so he could keep his care at UMMC, which has a nationally recognized liver transplant program.
The process has been a stressful one, he said, and that’s had an impact on his health.
“My numbers are back up. When I quit work, my MELD score dropped to 10 from a 16,” said Meredith, referring to his Model for End-Stage Liver Disease score, which is used as an indicator for how urgently someone needs a liver transplant. “Now it’s like 13 or 14, so it’s creeping back up.”
As of Sept. 1, Meredith is inured by Ambetter, which offers health care plans on the federal Marketplace and is accepted by UMMC. Like Frank Dungan, another former Blue Cross member and liver transplant candidate at UMMC, he is starting completely over with his deductible.
He will have to pay $6,000 out of pocket before his insurance kicks in this year, on top of the about $450 a month he pays in premium. In January, he will have to do it again.
Following his transplant, he will also have to pay for round-the-clock in-home care for anywhere from three weeks to three months.
As a result, he’s launched a GoFundMe to help him financially – a measure he is not comfortable having to take but feels he must.
So far, Meredith has raised nearly $8,000 of his $50,000 goal.
“I’ve never begged for money in my life,” said Meredith, a professional geologist. “… I’m not happy about having worked all my career, paid all my taxes, paid all my insurance premiums for years and years and years, and now they all evaporate or hold their hand out.”
Editor’s note: Kate Royals, Mississippi Today’s community health editor since January 2022, worked as a writer/editor for UMMC’s Office of Communications from November 2018 through August 2020, writing press releases and features about the medical center’s schools of dentistry and nursing. A longtime journalist in major Mississippi newsrooms, Royals had served as a Mississippi Today reporter for two years before her stint at UMMC. At UMMC, Royals was in no way involved in management decisions or anything related to the medical center’s relationship or contract with Blue Cross and Blue Shield of Mississippi.
The post Sumrall man drops Blue Cross, fundraises to afford liver transplant appeared first on Mississippi Today.
Read original article by clicking here.