For some Pitt students, UPMC could soon be out of network
By Steve Twedt, Pittsburgh Post-Gazette | |
McClatchy-Tribune Information Services |
For biology major
Ms. Smith, 20, from a small town south of
A friend drove her to
"I was in and out in an hour," said Ms. Smith. "It was really efficient. They were really, really nice to me."
She said she got a different reception Monday morning when a woman answered her call to the orthopedics office.
"She said, 'Our records say you have Community Blue [insurance], so we can't take care of you. You've got to find another doctor,'" Ms. Smith recalled. "She was kind of condescending."
In
That episode represented another chapter in the three-year dispute between UPMC, the region's largest health care provider, and Highmark, the region's largest insurer, over Highmark's move to establish its own provider network, the Allegheny Health Network.
After being turned away at UPMC, Ms. Smith phoned her mother, Denise, a Highmark employee based in
Ms. Smith got a new set of X-rays at each stop, three in all.
"I understand what's going on. I don't understand why it's going on," said Ms. Smith's father, Wayne, who has spent most of his career in insurance.
Although aware of the Highmark-UPMC battle, he said he thought it should have been resolved by now.
"She's a student at their university and it's their health system. How many other people are out there who have Highmark insurance and may be denied access to care when they are right down the street from it?"
UPMC spokesman
"Highmark designed Community Blue specifically to steer patients away from the care they would prefer to receive at UPMC," he said. "It's unfortunate that Highmark's marketing misrepresentations of the product have confused even its own employees."
Highmark spokesman
He added that "UPMC's refusal to treat patients solely on the source of payment is unprecedented in the health care industry."
Students are not required to buy the insurance, however, and many, like Ms. Smith, have insurance through their parents' coverage, particularly now that the Affordable Care Act allows young adults to stay on their parents' plan until age 26.
Of the 35,330 students at
A few block east on
Because UPMC now considers Highmark a competitor -- even though UPMC has its own health insurance arm that competes with Highmark -- UPMC says it will not renew or extend its current contract with Highmark past the
That dissolution may be particularly bewildering to Highmark-insured
Instead of walking across the street for a doctor's appointment or taking a quick bus ride down
Ms. Smith predicts many will have a reaction similar to her own.
"I was like, 'What do I do now?' UPMC is all I see every day. I was ignorant that there was even another hospital around here."
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