Transplant patients in limbo over coverage under UPMC-Highmark pact
By Luis Fábregas, The Pittsburgh Tribune-Review | |
McClatchy-Tribune Information Services |
"It's terrible. I've been asking questions for two years, and they keep telling me they don't know. They just totally ignore you. The transplant people are being held hostage because they can't get an answer," said heart transplant recipient
The retired state police officer, who received a new heart in 2007 at UPMC and has Highmark insurance, wants to know whether he can continue getting care at UPMC. A commercial contract between UPMC and Highmark expires in December and will not be renewed.
An agreement announced in late June by Gov.
Yet almost four weeks after the deal was announced, some organ transplant patients say they find themselves with little information. They worry where they will get post-transplant care and who will monitor their complex regimen of anti-rejection medications.
"We're really concerned," said
Spokesmen for both Highmark and UPMC said on Wednesday that patients who are in the midst of treatment will not have to change hospitals or doctors. They supplied answers about Killinger's case only after inquiries from the Tribune-Review.
"Inevitably, we're going to have some challenges explaining the mechanics of the transition," Pennsylvania Insurance Commissioner
Highmark spokesman
"It's up to the doctor and the patient," Billger said about Killinger's coverage. "If his doctor agrees to see him, Highmark will pay in-network rates."
Killinger said he received what looked like a form letter from the insurer that failed to provide a simple answer. He said he asked his transplant coordinator as recently as Tuesday what to do, and she told him she had not heard anything on the matter.
In response to questions from the Trib, UPMC spokesman
Wood acknowledged that UPMC front-line workers might not be familiar with the Highmark agreement because it is only a few weeks old.
"There are a lot of things to be sorted out. One of them is making sure the issues are properly communicated," Wood said.
In addition to organ recipients, Highmark members on the UPMC transplant waiting list are considered to be in the course of treatment, Wood and Billger said. Should a donor materialize, those patients will be able to get a transplant at UPMC, he said.
More than 10,000 patients have received organ transplants at UPMC since 1988, according to the
A transplant center based at
Killinger said he wants to stay at
If he changes insurance carriers, he would have to pay for it himself. He said he visits UPMC's clinic a few times a year for follow-up treatment and monitoring of his anti-rejection medicine.
"I'm doing fine. I feel good. But I feel like I'm in limbo," he said.
Luis Fábregas is
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