Highmark-UPMC split leaves patients wondering where they will get care
Crescent resident Judy Hays, a longtime Highmark health insurance member, has been treated for leukemia by UPMC doctors since 2010. But what really worries her is the prospect of being shut out with the end of the consent decrees between Pittsburgh health giants Highmark and UPMC.
“I’m facing the prospect of losing my oncologist,” Ms. Hays, 75, said at a news conference held Thursday by Pennsylvania Attorney General Josh Shapiro. “They’ve pulled me through, but after June 30, I don’t know where I’m going.”
Ms. Hays was among the people the attorney general’s office invited to discuss the impact of the Highmark-UPMC divorce as the state’s top lawyer announced a four-count civil action against UPMC in Commonwealth Court. He wants to force the health care giant to contract with any willing insurer, including Highmark.
Mr. Shapiro said he is confident the dispute can be resolved before consent decrees governing Highmark and UPMC expire at the end of June. He wants a new and modified agreement that would not expire.
In trying to explain why a deal between the two organizations matters, Mr. Shapiro described the experience of a first responder from Erie who assisted in the aftermath of the 2001 terrorist attack in New York City. She developed cancer as a result of exposure to toxic materials at the scene and has been treated by UPMC doctors.
Although she has health insurance through Medicare and two other plans, UPMC told the woman she could no longer receive treatment after June 30 because one of those plans was written by Highmark, the attorney general said.
“She is calling on UPMC to meet her medical needs,” Mr. Shapiro said.
His court filing cited a number of other examples of patients facing problems, including one with Parkinson’s disease who will be forced to travel more than 90 miles to receive specialized care, and a kidney transplant patient with a history of complications from the removal of her ovaries and fallopian tubes facing the loss of access to her UPMC specialists unless she switches insurers or prepays.
Experts have said that health insurance plans that provide access to both Highmark’s Allegheny Health Network and UPMC generally cost more than coverage limited to either network. Ms. Hays said she learned as much in getting quotes from other insurers.
For example, Aetna coverage giving her access to both networks would raise her co-pay for medical specialists to $40 from $15, and her scans would also cost her more, she said.
“Such a very sad situation,” she said in a prepared statement. “I feel like I am being held hostage.”