Hospital, insurer fight may presage more to come

Published 12:00 pm Friday, September 27, 2013

Aside from the obvious mission of providing medical care to patients, it’s clear that the second most important element of health care is who’s going to pay for treatment.

If Mississippians needed that point reinforced, it happened earlier this week when members of both the House and Senate insurance committees held a hearing in an attempt to hear both sides of a payment dispute between insurance company Blue Cross & Blue Shield and Health Management Associates, a Florida company that owns 10 Mississippi hospitals.

HMA sued Blue Cross in June, accusing the company of breaking the terms of a contract by reimbursing less than it promised for medical procedures. Blue Cross contends that HMA’s facilities overcharge the insured patients.

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This business dispute, if unresolved, is sure to affect Blue Cross customers who are accustomed to receiving care at HMA facilities.

Because of the lawsuit, Blue Cross ended its contract with HMA hospitals in August. …

Representatives of Blue Cross and HMA predictably pointed fingers at each other at Monday’s legislative hearing. But it would seem like BlueCross, which controls access to its customers and their insurance reimbursements, has the upper hand in this dispute.

At the hearing, the House Insurance Committee chairman said that if the problem cannot be resolved, the Legislature might have to pass a law to alter or eliminate insurance networks in favor of regulations that would let any hospital into a network if it meets requirements.

The state already has an “any willing provider” law for pharmacies. But it would be quite a step for the Legislature to extend that to hospitals, which provide far more expensive medical treatment than do pharmacies.

As the country prepares for the slow rollout of the Affordable Care Act, and the many unknown effects it will have on medical care, one concern is whether the new law will increase the friction between insurers and health care providers. If it does, the patients will most likely end up paying for it.