Monday, November 4, 2013

The Blue Cross/HMA lawsuit

Blue Cross-HMA.  HMA-Blue Cross.  The scrum between the two companies has dominated the news for quite some time in Mississippi.  The entire battle started with a lawsuit HMA filed against Blue Cross.  The media reported HMA filing the lawsuit but really has not analyzed the lawsuit, much less posted a copy of it for you to read.  JJ will attempt to do so in this post.
HMA* filed suit against Blue Cross/Blue Shield of Mississippi on June 18, 2013 in Hinds County Circuit Court and demanded a jury trial. HMA asked for actual and punitive damages against Blue Cross for breach of contract and alleged Blue Cross's actions cost HMA more than $13 million in 2012 and 2013.  HMA also asked the court to prohibit Blue Cross from modifying the contract between the two companies without its consent. 

Unfortunately for the readers, HMA did not attach a copy of the contracts to the lawsuit, citing confidentiality clauses.  However, HMA does quote an alleged passage that is common to each contract:

This agreement may be amended at any time during the term of the agreement by mutual written consent of duly authorized representatives of the parties.  Any changes to Attachment A policies and Procedures or Attachment B payment program shall be made known to the hospital in writing at least thirty days before the proposed changes are to become effective.  Said changes must be mutually agreed upon prior to implementation.
HMA will pummel Blue Cross with this "mutually agreed" clause over and over in the complaint.  HMA then quotes another passage alleged to be in each contract:

In the event of conflict between the provisions of this attachment B payment program and the participating hospital agreement or Attachment A policy procedures manual or attachment C APC polices and procedures manual, the provisions of this Attachment B shall prevail.

HMA states Attachment B provides the rates that Blue Cross must pay HMA.  HMA alleges that for years the two companies would negotiate rate increases as needed when costs and market conditions changed.  HMA claimed it could not reach an agreement with Blue Cross in late 2011 and the two have ever since remained at a stalemate.

Now the lawsuit gets technical so read slowly. ;-)  Remember Attachment A? The policies and procedures part of the contracts? HMA accuses Blue Cross of trying to "insert" into Attachment A some "provisions" that would change the reimbursements stated in Attachment B.  The alleged result is that while one section states the rates, the other section quietly changes them.  Needless to say that if true, HMA would not be happy about this action.   HMA argued it did not agree to any of these changes and that Blue Cross inserted the changes into Attachment A without its consent.  Pages 8-11 of the complaint provide more technical details in support of these allegations.

Its definitely a political-charged case as proved by recent events.  HMA alleges the ten hospitals represent ten percent of the population in Mississippi.  Blue Cross responded to the lawsuit by terminating network status for all ten hospitals although four rural ones were reinstated.  Blue Cross cited a clause in the contracts that allowed it to terminate network status if it gave HMA a sixty-day notice.  It is hard to analyze this case as the contracts were not attached to the complaint. The case was transferred to Rankin County Circuit Court.   Blue Cross may be correct under the contract as to how it terminated the hospitals.  However, HMA may win in court and still win a judgement against the insurer. 

*HMA Hospitals:  CMMC (Jackson), Biloxi Regional Medical Center, Crossgates River Oaks Hospital, Gilmore Regional Medical Center (Amory), Madison River Oaks Medical Center, Natchez Community Hospital, Northwest Mississippi Regional Medical Center (Clarksdale), River Oaks Hospital (Flowood), Tri-Lakes Medical Center,, Woman's Hospital at River Oaks (Flowood)


4 comments:

Anonymous said...

Excellent reporting.

"The alleged result is that while one section states the rates, the other section quietly changes them"
I didn't know BCBS was part of the Obama administration.

Anonymous said...

i have been harsh in my comments about BCBS of MS in the past....while i still hold those beliefs, there is no doubt whatsoever that HMA is every bit as vicious. these observations come from long familiarity with both institutions even though HMA is constantly changing into something nobody has seen before

nmisscommenter said...

trying to read pages 8-12 of the complaint made me dizzy.

Anonymous said...

hahaha. Good one, NMC.



Recent Comments

Search Jackson Jambalaya

Subscribe to JJ's Youtube channel

Archives

Trollfest '09

Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).


Meet KIM Waaaaaade at the Entergy Tent. For five pesos, Kim will sell you a chance to win a deed to a crack house on Ridgeway Street stuffed in the Howard Industries pinata. Don't worry if the pinata is beaten to shreds, as Mr. Wade has Jose, Emmanuel, and Carlos, all illegal immigrants, available as replacements for the it. Upon leaving the Entergy tent, fig leaves will be available in case Entergy literally takes everything you have as part of its Trollfest ticket price adjustment charge.

Donna Ladd of The Jackson Free Press will give several classes on learning how to write. Smearing, writing without factchecking, and reporting only one side of a story will be covered. A donation to pay their taxes will be accepted and she will be signing copies of their former federal tax liens. Ms. Ladd will give a dramatic reading of her two award-winning essays (They received The Jackson Free Press "Best Of" awards.) "Why everything is always about me" and "Why I cover murders better than anyone else in Jackson".

In the spirit of helping those who are less fortunate, Trollfest '09 adopts a cause for which a portion of the proceeds and donations will be donated: Keeping Frank Melton in his home. The “Keep Frank Melton From Being Homeless” booth will sell chances for five dollars to pin the tail on the jackass. John Reeves has graciously volunteered to be the jackass for this honorable excursion into saving Frank's ass. What's an ass between two friends after all? If Mr. Reeves is unable to um, perform, Speaker Billy McCoy has also volunteered as when the word “jackass” was mentioned he immediately ran as fast as he could to sign up.


In order to help clean up the legal profession, Adam Kilgore of the Mississippi Bar will be giving away free, round-trip plane tickets to the North Pole where they keep their bar complaint forms (which are NOT available online). If you don't want to go to the North Pole, you can enjoy Brant Brantley's (of the Mississippi Commission on Judicial Performance) free guided tours of the quicksand field over by High Street where all complaints against judges disappear. If for some reason you are unable to control yourself, never fear; Judge Houston Patton will operate his jail where no lawyers are needed or allowed as you just sit there for minutes... hours.... months...years until he decides he is tired of you sitting in his jail. Do not think Judge Patton is a bad judge however as he plans to serve free Mad Dog 20/20 to all inmates.

Trollfest '09 is a pet-friendly event as well. Feel free to bring your dog with you and do not worry if your pet gets hungry, as employees of the Jackson Zoo will be on hand to provide some of their animals as food when it gets to be feeding time for your little loved one.

Relax at the Fox News Tent. Since there are only three blonde reporters in Jackson (being blonde is a requirement for working at Fox News), Megan and Kathryn from WAPT and Wendy from WLBT will be on loan to Fox. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both and a torn-up Obama yard sign will entitle you to free drinks served by Megan, Wendy, and Kathryn. Get your tickets now. Since this is an event for trolls, no ID is required. Just bring the hate. Bring the family, Trollfest '09 is for EVERYONE!!!

This is definitely a Beaver production.


Note: Security provided by INS.

Trollfest '07

Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

Note: Security provided by INS
.