Erie heart program to continue despite Highmark cut

Dec. 08--ERIE, Pa. -- An Erie program designed to help people with heart disease will continue to operate in 2016 even though Highmark Blue Cross Blue Shield will no longer cover the costs for the insurer's members.

UPMC Hamot has run the Dean Ornish Program for Reversing Heart Disease since 2003. It provides participants with dietary education, exercise classes and stress-management sessions.

Highmark officials said the insurer will stop covering the program's $5,700 cost for members at the end of 2015.

The decision has nothing to do with the increased competition between Highmark and UPMC, said Highmark spokesman Aaron Billger.

"(T)here is one single provider of the Ornish program in Western PA," Billger said in an e-mail, referring to Hamot. "One provider alone does not facilitate enough network access to have a benefit offering, based on PA insurance guidelines. Thus, without a provider network to meet PA insurance rules, we can no longer offer an Ornish benefit in Western PA because there isn't a PA-approved network to accommodate members."

Though Highmark remains the area's dominant private health insurer, there are enough insurance providers available to cover the Ornish program costs to keep it running, said Debbie DeAngelo, R.N., who oversees the program as director of Hamot's Center for Healthy Living.

"Medicare, Aetna, Anthem BCBS and UPMC Health Plans, as well as some Highmark plans, continue to provide coverage for the program," DeAngelo said. "We do not anticipate a significant impact."

Highmark will only cover the costs for Ornish participants in Erie who enrolled in 2015, Billger said. The insurer will cover the costs for those enrolled in a Charleston, W.Va., Ornish program because West Virginia's insurance laws are different.

Twelve people are enrolled in the current Ornish program in Erie. Those with Highmark insurance can still join the Ornish program, but they would have to pay the costs out of their own pockets.

DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.

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