‘A reign of terror on seniors’
Pa. attorney general, county controller target access, cost issues related to breakup of Highmark-UPMC
Pennsylvania Attorney General Josh Shapiro’s office is conducting a wide-ranging review of the Highmark-UPMC split, four months before tens of thousands of Western Pennsylvania residents will be forced to pick one health care system over the other for medical care.
The attorney general’s office, which has created a special consumer telephone helpline and online complaint form for the HighmarkUPMC split, is focusing on issues of access to medical services and consumer costs, Chief Deputy Attorney General Mark Pacella said Monday.
In recent months, the office also has been reviewing complaints about access problems to a UPMC hospital by employees of a specialty metals company in Lycoming County.
“When you get into litigation,” Mr. Pacella said, “you need more than anecdotal information.”
At a public meeting Monday in McKeesport, Mr. Pacella declined to say whether the complaints would be used to intervene in the Highmark-UPMC dispute, but said Mr. Shapiro was “acutely aware” of problems created by the split.
Relations soured between Highmark and UPMC in spring of 2011 over amounts paid to UPMC for treating Highmark members. The final break came in the fall of the same year when Highmark approved the acquisition of the former West Penn Allegheny Health System, competing directly with UPMC for patients and insured members.
Consent decrees brokered by the state that have allowed some Highmark members to continue seeing UPMC doctors expire June 30, virtually ending relations between the Pittsburgh health care giants and in-network access to UPMC for Highmark members.
The McKeesport session on Monday, which drew about 20 people, was the first of five meetings scheduled by Allegheny County Controller Chelsa Wagner to air grievances about how consumers have been hurt.
Ms. Wagner counseled the group against complacency about the split, which she said should not be thought of as inevitable. “These are public assets that have not only been subsidized by the public, but built by the public,” she said. “I think it’s part of a reign of terror on seniors. It’s just not right.”
According to a spokeswoman for Ms. Wagner, Highmark and UPMC representatives did not respond to invitations to attend Monday’s meeting, which was held at the Carnegie Library.
In a statement issued last month, UPMC spokesman Paul Wood dismissed problems related to the Highmark breakup, saying the region’s health insurance environment had become among the most competitive, pro-consumer markets in the country in recent years.
Highmark took a different stance, saying in a statement that “every charitable, tax-exempt organization has a fundamental obligation to ensure that the community has open access to assets that the community has funded and supported,” spokesman Aaron Billger wrote. Highmark has pledged public access to its facilities, regardless of type of health insurance.
Among the people affected by the end of the fiveyear consent decrees between Highmark and
UPMC are an estimated 175,000 seniors with Highmark Medicare Advantage coverage in Allegheny and Erie counties. After the end of the consent decrees, UPMC has said it will require these consumers to pay upfront for care.
White Oak resident Lori Katich, who was covered by UPMC Health Plan for years, attended Monday’s meeting to share her experiences.
Ms. Katich, 56, who was diagnosed with a brain tumor in 2004, said she has been treated for years by UPMC neurosurgeon Daniel Wecht. In 2011, Dr.
Wecht told her the tumor had grown and had to be removed, which was done the same year.
Fortunately, the tumor was benign.
But in 2016, her husband Stephen’s health insurance carrier switched to Highmark, meaning Ms. Katich will not be able to see Dr. Wecht as an in-network provider after June 30. She is shopping for a new doctor who will be starting from zero in understanding her treatment, which has stretched over 14 years, she said.
“It’s just someone I trust,” she said. “It shouldn’t be like this. It’s affecting everyone.”
In filing complaints, Mr. Pacella advised the group to focus on problems they’ve experienced accessing medical care and the costs of alternative health insurance coverage caused by the split.
“It’s important for us to understand that,” he said.
Consumers seeking innetwork access to both UPMC and Highmark doctors are likely to pay higher health insurance premiums than if their coverage were limited to one network, said Rick Galardini, chairman and CEO of Wexford-based brokerage JRG Advisors LLC, who did not attend Monday’s meeting.
UPMC operates most of the hospitals in Allegheny County, although Highmark’s Allegheny Health Network is building new facilities.
“Highmark is saying we’re as good or better than UPMC and also cheaper, so come to us,” Mr. Galardini said. Still, “I think they’d love to have an agreement with UPMC.”
Ms. Wagner, who said she supported a challenge of UPMC’s nonprofit tax exemption, said she has had “very promising conversations with the attorney general’s office” in recent months about the Highmark-UPMC breakup. She declined to discuss details.
Ms. Wagner has no authority to audit Highmark or UPMC, but recently launched a petition drive asking Mr. Shapiro and other elected officials to intervene. Her next public hearing is Thursday at CCAC South in West Mifflin.
“These are public assets that have not only been subsidized by the public, but built by the public. I think it’s part of a reign of terror on seniors. It’s just not right.” — Chelsa Wagner, Allegheny County Controller