The UPMC/Highmark "Divorce" Affects Us All

UPMC and Allegheny Health Network facilities were built on the backs of our residents through our dollars and their exemptions from taxes as non-profits. But after June 30, many Western PA residents will be shut out of one of our regional health care networks. Seniors and cancer patients are just the latest to be held hostage by the “divorce” of our local health care giants.

We believe that every local resident deserves access to the hospitals and doctors that serve them best, regardless of their insurer.

These entities must be held to their commitments as tax-exempt “charities” to serve the public, and made to cease their predatory behavior.

Tell our public officials to ACT to protect health care access for our families and neighbors.

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Tell our public officials to ACT to protect health care access for our families and neighbors.

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Has the UPMC-Highmark “divorce” affected your access to care? Tell us your story.

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Download and print a paper copy of the petition below. Return any number of signatures to:

Controller Chelsa Wagner
Allegheny County Court House
436 Grant Street
Suite 104
Pittsburgh, PA 15219

How has the UPMC-Highmark “divorce" failed Western PA residents?

ACCESS DENIED

In Allegheny County, many Highmark members lost in-network access to UPMC at the end of 2014. However, consent decrees kept emergency, trauma, and cancer services in-network, and limited the amount that Highmark and UPMC could charge out-of-network patients. The consent decrees also allowed patients in the middle of treatment and those enrolled in Medicaid, CHIP, and Medicare Advantage to remain in-network. When the consent decrees expire on June 30, 2019, these protections will end.

SENIORS SHUT OUT

The end of the consent decrees will have a significant impact especially on seniors in the region. Allegheny County has one of the largest concentrations of seniors covered by Medicare Advantage in the country. As of November 2018, more than 162,000 of the county’s seniors were covered by Medicare Advantage. Many of these seniors will find their longtime doctors and hospitals out-of-network when the consent decrees expire.

‘HARSH’ PRACTICES

UPMC has gone a step further, saying it would require the newly out-of-network Highmark Medicare Advantage patients to pay in advance, and partial payments or payment plan arrangements will not be accepted.  Steve Foreman, a professor of health care administration at Robert Morris University, described UPMC’s prepay requirement as “unusual” and “harsh,” telling the Tribune-Review, “He never has seen any insurers force out-of-network patients to pay their entire bills in full before receiving a medical service.”

SHOCKING BILLS

For those with out-of-network insurers, hospitals can charge exorbitant rates, then bill patients for the difference between what the insurer is willing to pay and the hospital charges – a practice known as “balance billing.” For instance, a patient with Highmark insurance who finds herself in a UPMC emergency room would be charged the out-of-network rate; if that’s less than what Highmark is willing to pay, she would have to pay the difference, which could run tens of thousands of dollars. (The same would be true for a patient with UPMC insurance who ends up in an Allegheny Health Network emergency room.)

UNCHECKED EXPANSION

UPMC and AHN have announced plans to spend a combined $3 billion on new, tax-exempt hospitals in the region in the coming years, hospitals to which many in our region will be denied access.

WALLS PUT UP

UPMC has locations in four foreign countries and markets itself to patients around the world. Yet those in its own backyard will be denied its “Life Changing Medicine” if they choose the wrong insurer. As health care consumers from around the world flock to Pittsburgh for “World-Class Care,” it is unconscionable to build walls between our own residents and the doctors and hospitals that serve them best.

Take Action

Legislation introduced in Harrisburg would require that health networks like UPMC and Highmark which operate as both health care providers and insurers cannot turn away patients covered by another insurer that is willing to pay for their care. Ask your State Senator to support Senate Bills 310 & 311 by Sen. Costa, and your Representative to support House Bills 1211 & 1213 by Rep. Frankel. Call today!

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