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Community Blue spat aired before House panel

| Tuesday, April 30, 2013, 12:21 a.m.

When Marie Acquafondata retired in November after 40 years at UPMC Shadyside and switched to her husband's Community Blue health plan through Highmark Inc., she was surprised when UPMC later told her it wouldn't accept her insurance.

She had breast cancer about five years ago.

“I still go for six-month checkups. The same radiation oncologist had been taking care of me for five years,” said Acquafondata, 64, of Bloomfield, whose husband works for West Penn Hospital. “I had to find a new radiation oncologist.”

Acquafondata and others told similar stories on Monday at a public hearing before the state House Democratic Policy Committee in Pittsburgh. The committee heard proposals from health care experts on how to fix health care problems.

The hearing focused largely on the ongoing battle between regional health care giants UPMC and Highmark. The state on Monday approved Highmark's $1 billion bid to buy West Penn Allegheny, the second-largest hospital system in the region.

Highmark executives told the lawmakers that UPMC is improperly denying care to Community Blue members.

UPMC said in a statement that Highmark executives misled subscribers about the plan, which does not include UPMC services.

“It appears the real problem for UPMC is that (these people) have Highmark insurance,” said Dr. Donald Fischer, chief medical officer for Highmark. “Physicians cannot simply abandon patients.”

UPMC's chief legal officer, W. Thomas McGough Jr., wrote lawmakers that Highmark's argument “is completely fallacious” and that Highmark was aware that Community Blue subscribers would have no out-of-network benefit at UPMC facilities.

McGough said UPMC would allow Community Blue patients access to UPMC facilities at out-of-network costs if Highmark waives a prohibition that keeps UPMC from billing patients for the balance.

Kristin Ash, Highmark spokeswoman, said UPMC's offer “doesn't look like a viable option” and that Highmark agreed to pay UPMC slightly higher rates to accommodate Community Blue out-of-network patients.

“It's not what we agreed to in the contract, and really, from our perspective, it's another way for them to make money,” Ash said.

Bobby Kerlik is a staff writer for Trib Total Media.

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