Needing immediate care, liver transplant candidate drops out of Blue Cross | New

Madison’s Frank Dungan is in need of a liver transplant, but the focus of his final months hasn’t been his health. He focused on a battle between his insurance company and his hospital that left him without insurance coverage under the state’s only organ transplant program.

But since July 1, Dungan has changed insurers, and he is receiving the medical care he had to postpone – and, more importantly, he is back to “active” status on the transplant list.

After Dungan Hospital, University of Mississippi Medical Center (UMMC), went out of the network with its insurer Blue Cross & Blue Shield of Mississippi on April 1, Dungan spent months trying to get medical answers about what it meant to him. The UMMC marked him as “inactive” on their transplant list, which means that if the perfect liver match became available, he would not receive a call.

Blue Cross directed him to the transplant program in Memphis, which was more than three hours from his home, a logistical and financial nightmare. He knew very little about the program and had spent years building relationships with his doctors at UMMC, home to the state’s only transplant program.

Neither Blue Cross nor UMMC would get answers on what the out-of-pocket costs would be if he received the transplant through UMMC while still out of network with Blue Cross. In May, Mississippi Insurance Commissioner Mike Chaney stepped in and sent a letter to the insurer and UMMC asking them to provide him with what he needed.

But Dungan said he couldn’t get definitive answers and never received anything in writing.

“It was to the point of driving you crazy. Every time the phone rang you were trying to figure out what other scary problem we had,” he said.

UMMC and Blue Cross had agreed to mediation in an attempt to settle the contract dispute, but more than two months after the network’s discharge from hospital, a resolution still seems unlikely. Neither UMMC nor Blue Cross will speak publicly about the progress of the negotiations.

The dispute stems from disagreements over reimbursement rates, with the UMMC insisting that Blue Cross is not fairly reimbursing the safety net hospital for its services and that keeping Blue Cross’s rate hike would require an increase. substantial member premiums. Hospital reimbursement rates are not public.

In June, while making his appointments with various specialists before the expiry of the continuity of care grace period for certain Blue Cross members at UMMC on July 1, one of his doctors found something worrying. He had esophageal varices, a condition that requires a medical procedure that uses elastic bands to tie off bleeding veins. If left untreated, varicose veins can rupture and cause severe internal bleeding.

The condition usually occurs in people with severe liver disease.

Dungan said her doctor at UMMC told her the banding procedure would be “on me.”

Dungan was scared. He worried as he went to bed each night if that would be the night he would bleed. He knew something had to change.

“I found an insurance advisor (Marketplace) and asked him if there were any options (for me)…You see, my insurance agent in my hometown told me that you don’t couldn’t get health insurance except in December, even though he gave me the wrong information,” Dungan said. “I was concerned about that, concerned about the bonuses, concerned about the language… I didn’t understand some of the language (of the policies).”

He got in touch with an insurance broker trained in federal market plans and found he didn’t have to wait until December to sign up for a plan.

“She explained the details of the policy to me and I found that it covered what I needed,” he said. “She explained the deductible, the disbursements and the premium, everything.”

Dungan, who had an individual policy with Blue Cross, is now covered by Ambetter, which offers health care plans in the federal market and is accepted by UMMC. He underwent two procedures to treat esophageal varices earlier this month and visited his dentist to make sure he had no infections in his mouth – a requirement to reclaim his place on the transplant list .

Switching insurance is not an option for some people, especially those whose employers only offer Blue Cross to employees.

But he is starting from scratch with his insurance: he has a new disbursement limit to respect of approximately $8,000. But his monthly premium went from nearly $1,200 with Blue Cross to $402 with Ambetter, he said.

“I’m back confident that I’m getting good health care and confident that my bills won’t be outrageous,” Dungan said. “I’m confident that (the doctors at UMMC) are keeping an eye on me.”

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