Myths vs Facts

UPMC’s New “Agreement:” MYTHS and FACTS

 

MYTH: Cancer patients are now guaranteed access to all UPMC facilities, regardless of their insurance plan

UPMC has agreed to make its Hillman Cancer Center locations available to all insurers. However, UPMC’s announcement was short on details, and right now there is no written agreement with Highmark. Cancer patients often require other types of specialized care as part of their treatment. For example, Beth McCracken, who has been battling a rare form of ear cancer, also has a team of doctors at UPMC’s Ear, Nose, and Throat Clinic. If the final agreement doesn’t include cancer-related treatment at all UPMC facilities, cancer patients like Beth will still lose access to many of their doctors.

 

MYTH: UPMC dropped its prepay rule entirely

UPMC is dropping its prepay rule for seniors enrolled in Highmark’s Freedom Blue and Security Blue Medicare Advantage plans. However, over 25,000 seniors enrolled in Highmark’s Community Blue Medicare Advantage plans will still be forced to pre-pay. Also, as the Tribune-Review noted:

 

“The change will not lift the prepay rule for younger patients insured by Highmark either through their employer or via Highmark insurance purchased through the federal health exchange. Those Highmark customers still would have to pay in full prior to receiving non-emergency procedures at most UPMC hospitals.”

 

MYTH: Now patients don’t have to worry about access to UPMC’s specialty hospitals

While UPMC has agreed to give all insurers in-network access to Hillman Cancer Centers for now, without a written agreement it could revoke that access at any time.

 

UPMC’s statement about Hillman also said that Western Psychiatric and Children’s Hospital “will remain accessible to all.” However, UPMC is currently required to offer access to these hospitals under previously negotiated agreements with Highmark. The contract for Children’s Hospital expires in 2022 and the Western Psych agreement expires in 2024. UPMC has been intentionally vague about what it plans to do when those agreements expire.

 

MYTH: Because UPMC made these announcements before the consent decree expires, no patients were harmed

For months UPMC told cancer patients and seniors that they would lose access to their doctors and hospitals on June 30. In addition to causing unnecessary stress to critically ill patients, many patients had begun to look elsewhere for care.

 

For example, at a town hall in February, Vicki Arnett described how her husband, who has Highmark insurance, was diagnosed with stage 4 colon cancer at a UPMC hospital in October. She says that UPMC sent him home to wait while it decided whether to treat him, knowing that he would lose access when the consent decree expired. Five days later he was rushed to an emergency room with a blocked colon, which might have been diagnosed sooner had UPMC began treatment immediately. He is currently flying back and forth to Atlanta in order to get in-network treatment for his advanced cancer.

 

MYTH: UPMC engaged with patients

Some local officials claim that this agreement was arrived at by “engaging with all parties.” In reality, the most important parties—the patients—have known nothing but uncertainty and fear. Patients and advocates have spent months seeking action and answers without a word from the officials making this announcement.

 

At our town halls and on our website, HealthcarePgh.com, patients shared stories about what would happen to them when the consent decree expired. Back in March, UPMC did ask us about some of them, but not about Beth, or Vicki’s husband, or any of the people losing access to their doctors. Instead, UPMC asked only for information on three people who appeared to have non-Highmark coverage, because UPMC is trying to get contracts with their insurers (who are based in other regions), even as it denies access to Highmark patients here at home.

 

MYTH: No further action is needed

If anything, UPMC’s recent actions show why it’s so important to demand action from our state legislators. As one local healthcare consultant explained, UPMC’s recent decisions to allow access have little to do with protecting patients and everything to do with UPMC’s business strategy:

 

"Their tactic — which is working — is to create as much disruption, turmoil, and anxiety as possible in the market in advance of enrollment decisions in order to convince people to move out of Highmark products. Once accomplished, they will backtrack as much as needed to reduce the actual volume loss to the hospitals."

 

UPMC has done this before, and we expect that they’ll follow the same game plan again, during the next Medicare enrollment seasons and when Highmark’s contracts with Children’s Hospital and Western Psychiatric expire.

 

Luckily there are bills in the state legislature right now that would keep these healthcare giants from holding patients hostage and ensure that everyone has access, regardless of their insurer. Now is not the time to stop. Now is the time to pass legislation and issue rulings to ensure that we ALWAYS have access to ALL of our charity hospitals.

 

Our state legislators still need to hear from us-- find your legislators here.