Letter to the Editor: Blue Cross Blue Shield/UMMC debacle
Sylvia Taylor is a law student at Mississippi College School of Law
I am writing to highlight and expand on the concerns raised in the WLBT article: “Blue Cross Blue Shield subscriber needing surgery is caught in the middle of the battle with UMMC”.
The article describes a Mississippi citizen suffering from the unsettled dispute between UMMC and Blue Cross Blue Shield; however, this is just one of many Mississippians affected by this issue. The longer this issue drags on, the longer Mississippians will be used as pawns in a game.
Blue Cross Blue Shield is one of the largest health care insurers in Mississippi. Health insurance prices are astronomical, especially when purchased through a private insurance company.
As a result of these insane costs, most people receive their insurance through their job. However, employers use a cost-sharing system-- meaning the employee still has to pay a significant amount for their health insurance.
Since Blue Cross Blue Shield is one of the largest health care insurers in Mississippi and most people receive their insurance through their jobs, many Mississippians are basically forced to have Blue Cross Blue Shield as their insurer. Thus, creating a lack of competition between providers.
Lack of competition creates monopoly-like behavior by the dominant provider because they can continue to raise prices and choose what care/treatment they will cover. A market must operate by supply and demand because consumers need to know how much the product costs to make their decisions.
However, the physicians provide both the supply and demand, leaving the patient out of all market decisions.
Blue Cross Blue Shield was the dominant provider and decided to force UMMC out of its network. Likely because they are trying to avoid the “death spiral.” The death spiral is when insurance companies put more money out than they bring in through premiums.
Blue Cross Blue Shield argues that UMMC was costing them too much money compared to the other hospitals in Jackson, such as St. Dominick’s and Baptist. However, this is not a valid comparison since UMMC is the only #1 trauma center in the state and the only academic hospital in Mississippi.
Coupling these facts demonstrate that UMMC will cost providers, such as Blue Cross Blue Shield, more money because they take intense and cost-heavy patients that other hospitals do not have the ability to care for.
The ACA reform law prohibits insurance companies from keeping people out with preexisting conditions.
However, it’s almost as if Blue Cross Blue Shield is trying to go around this prohibition by forcing UMMC out of its network. With UMMC out of their network, Blue Cross Blue Shield avoids paying for all of the extreme and costly patients that come along with being a payer for the #1 trauma center for the state.
As a result, dodging the death spiral.
Once Blue Cross Blue Shield stopped being a payer for UMMC, they subjected patients to higher out-of-pocket costs. Thousands of Mississippians have been affected by this catastrophe with no solution in sight.
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