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UPMC errs in rejecting Michigan patients with Community Blue plan

| Saturday, May 11, 2013, 12:01 a.m.

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.

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