UPMC errs in rejecting Michigan patients with Community Blue plan
Several UPMC patients with health insurance through a Michigan company were caught up recently in the hospital network's battle with Pennsylvania health insurer Highmark Inc.
Blue Cross Blue Shield of Michigan offers a health plan called Community Blue, the name Highmark gave its product designed to exclude UPMC's hospitals and doctors.
Though UPMC accepts the Michigan Community Blue plan, the system turned away some patients because employees mistook the name for Highmark's plan.
“It seems like it's an isolated incident,” said Helen Stojic, a spokeswoman for Detroit-based Blue Cross Blue Shield of Michigan.
That company provides coverage to 5 million people, including about 30,000 who live in Western Pennsylvania and are insured through a Michigan-based employer.
The company is aware of several cases in which its Community Blue members had trouble receiving care at UPMC, Stojic said. But, she said, “our members are still being accepted” by UPMC.
UPMC is aware that some workers were confused, but it has corrected the problem, spokesman Paul Wood said.
Highmark's Community Blue became part of the ongoing spat between UPMC and Highmark this year. The insurer introduced it in January as a lower-cost alternative to its traditional insurance plans.
Highmark said companies and individuals could save up to 25 percent with the plan because it does not include UPMC as an in-network medical provider.
UPMC told patients who signed up for Community Blue that its hospitals and doctors no longer would treat them. That drew a rebuke from Highmark, which claimed members could utilize UPMC if they paid the higher out-of-network fees.
UPMC disputes that position and has refused to see Highmark Community Blue patients. UPMC last week proposed that Highmark alter the plan to allow UPMC to bill Community Blue patients directly for the full cost of treatments, a practice known as balance billing.
Highmark rejected the proposal, spokeswoman Kristin Ash said.
“UPMC's proposed solution is not one that is in the best interest of our members, who would be subjected to thousands or tens of thousands worth of bills from UPMC,” Ash said.
Alex Nixon is a staff writer for Trib Total Media.
Add Alex Nixon to your Google+ circles.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- 153-year-old Venango well pumps out oil, history
- Small retailers at intersection of social networks, foot traffic
- Woman on dating site looks too good to be true: How to vet that pic
- In ‘StockCity,’ real investing like game
- Test-tube tuna may be sea change
- Business Council for Peace program works to export profits, peace
- Iron ore price decline hurts U.S. Steel’s cost advantage over rivals
- Health care, gas drilling industries await Gov.-elect Wolf’s footprint
- Ford: Aluminum-body truck to get 26 mpg
- U.S. Steel reorganizes operating units
- Highmark and UPMC feud over canceled physician contracts