Blue Cross files defamation lawsuit to set record straight regarding UMMC network negotiations | Mississippi Politics and News

BCBS statements UMMC’s advertisement campaign is maliciously developed to injure their name and improperly coerce them into a new agreement that gains UMMC. 

The insurance plan large, Blue Cross Blue Shield of Mississippi (BCBS), is professing in a the latest lawsuit that staff members of the University of Mississippi Professional medical Middle (UMMC) engaged in a defamatory general public relations campaign from the business.

The fit will come soon after a really general public marketing campaign across the condition on several on line platforms and billboards that insinuates that BCBS dropped UMMC from coverage. That marketing campaign is approximated at around $280,000 at this place with more advertisement placement purchases currently established.

Y’all Politics documented earlier this week that the funds being utilized for the UMMC advertisement campaing towards BCBS are currently being paid out by means of the hospital’s “health method profits accounts,” or primarily affected individual functions.

Examine More: Where’s the funds coming from at UMMC to fund PR offensive towards Blue Cross?

BCBS claims in the grievance that these allegations are not real.  BCBS claims that on January 28, Dr. LouAnn Woodward notified BCBS that UMMC was ending its Skilled Provider Network Settlement voluntarily. This termination letter was included in the court filings.

The suit incorporates the subsequent: Depend 1 – Defamation, Depend 2 – Civil Conspiracy, and Rely 3 – Injunction.

The fit promises that UMMC chose to cancel or hold off appointments, call for whole payment right before providers, deactivate approved clients from transplant lists and refuse treatment all on their personal. BCBS promises that they would continue on to fork out Community amount positive aspects for included clinical solutions, in spite of the arrangement termination.

BCBS states that they have been a company for UMMC for decades, until eventually in 2018 the medical center terminated its Clinic Network Agreements with Blue Cross, stating it really should be reimbursed at rates that were “significantly increased than similar Network providers through the condition.”  The two eventually came to an settlement in 2018.

The most modern agreement was set to expire in July 2021, but several extension requests ended up built by UMMC and approved by BCBS, until eventually early 2022 when the two began to negotiate new terms.

The lawsuit outlines what then transpired:

“UMMC demanded sizeable, unrealistic payment improves throughout all healthcare facility provider parts, contending that it and its doctors, nurse practitioners and other allied suppliers must be paid out at costs substantially higher than other Network hospitals and health care providers during the Condition. Blue Cross proposed reimbursement increases for particular companies and supplied additional reimbursements by Blue Cross’ high-quality application built to strengthen individual results. UMMC refused to accept the proposed reimbursement will increase and refused to participate in the good quality application supplying additional raises tied to enhanced high quality actions. As a substitute UMMC managed it is entitled to a 30% general increase yr just one with escalating raises thereafter each year, which would incorporate a 50% increase for specific providers.”

The lawsuit was exclusively filed versus three men and women: Dr. LouAnn Woodward, the Vice Chancellor for Wellness Affairs and Dean of the University of Medicine Affiliate Vice Chancellor for Clinical Affairs Dr. Alan Jones and Govt Director of Communications and Marketing Marc Rolph.

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

The accommodate provides precise statements produced by Woodward, Jones and Rolph relating to the ongoing negotiations with BCBS. This features feedback designed by Dr. Woodward immediately after her January 28 termination letter was sent to BCBS.

Some of all those statements are demonstrated below from the filing: 

The go well with outlines dozens of more statements and general public campaign content, that they say are defaming and untrue, pertaining to the situation surrounding the community negotiations.

The defendants had been also found indicating, “Blue Cross is denying you uninterrupted access to [UMMC] services,” which BCBS states is not real.

BCBS extra that they have informed its customers that they can go on to get treatment at UMMC for which BCBS will reimburse UMMC at Network Level benefits. On the other hand, they claim UMMC has refused to handle certain BCBS associates for that Community degree reward, but not all.

Blue Cross maintains that underneath the No Surprises Act, when an uninsured or self-fork out individual seeks treatment at that specific healthcare facility, UMMC is obligated to inform the affected individual of the correct to get a excellent religion estimate of costs. This obligation comes about quickly when UMMC terminates, cancels, or delays any therapy merely on the foundation that the man or woman is self-shell out or uninsured.

Moreover, BCBS says that UMMC is demanded to offer a superior religion estimate for a member who seeks an unscheduled non-crisis remedy.

Mississippi Coverage Commissioner Mike Chaney talks about the “two stubborn Goliaths” – BCBS and UMMC – at the Neshoba County Reasonable this week, declaring the two should negotiate and obtain a compromise.

You can browse the whole go well with underneath.

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