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Miss. lawmakers hear about BlueCross-HMA dispute

Emily Wagster Pettus, Associated Press

JACKSON, Miss. (AP) -- Mississippi lawmakers said Monday they hope the state's second-largest hospital company and largest health insurer will resolve a financial dispute before patients lose care or facilities close.

Health Management Associates, a Florida-based company that owns 10 Mississippi hospitals, sued Blue Cross & Blue Shield of Mississippi for $13 million in June, saying that the insurance company broke contract terms by underpaying for procedures. Blue Cross says HMA overcharges.

Several days after the lawsuit was filed, Blue Cross gave notice that it was ending its contract with HMA as of Aug. 30. The suit is still pending.

Since Sept. 1, the 10 HMA hospitals have been out-of-network for Blue Cross, meaning patients eventually could face higher out-of-pocket expenses. For now, some hospitals, such as Tri-Lakes Medical Center in Batesville, are not charging out-of-network costs to patients, said Dr. Mike Haven, a family medicine physician at Tri-Lakes.

Representatives of HMA and Blue Cross addressed the state House and Senate insurance committees Monday at the Capitol.

House Insurance Committee Chairman Gary Chism, R-Columbus, said if the dispute isn't resolved by January, legislators might need to consider a bill that would alter, or possibly eliminate, insurance networks for hospitals. Mississippi already has an "any willing provider" law for pharmacies, which requires managed care organizations to let any pharmacy join a network if the pharmacy meets network requirements.

If such a law were extended to hospitals, it could limit the ability of insurance companies to exclude whole groups of hospitals from network participation. Chism said a law could be written to cover all hospitals or only to cover certain services, such as OB-GYN coverage.

"I know it's going to defeat the purpose of some of the networks," Chism said of a possible law. "It may cost a little more money, but we'll see."

Paul Hurst, an attorney who is senior vice president of government affairs for HMA, told lawmakers Monday that some hospitals, particularly in rural areas, could close because Blue Cross kicked them out of network.

"This is Blue Cross against the people of Mississippi," Hurst said. "It's Blue Cross against patients."

Charles Pace, director of governmental affairs for Blue Cross, responded later: "Any closure is not the result of Blue Cross ...The people that own these hospitals are the ones that make those decisions, not Blue Cross."

HMA's Mississippi facilities are Biloxi Regional Medical Center, River Oaks Hospital and Woman's Hospital in Flowood, Crossgates River Oaks Hospital in Brandon, Madison River Oaks Medical Center in Canton, Central Mississippi Medical Center in Jackson, Natchez Community Hospital, Gilmore Regional Medical Center in Amory, Northwest Mississippi Medical Center in Clarksdale and Tri-Lakes Medical Center in Batesville.

Dr. Shani Meck, an OB-GYN, told lawmakers if the dispute between HMA and Blue Cross is not resolved, some of her patients who've been planning to give birth at the HMA hospitals in Flowood will instead have to go to other hospitals several miles away. She said without the HMA hospitals, there are likely to be too few labor and delivery rooms or surgery rooms to handle the number of births in the Jackson area, and that could lead to women being in labor or even giving birth in hospital hallways.