Community Blue spat aired before House panel
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.
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.
- Pittsburgh Police motorcycle officer seriously injured in crash
- 2 killed in single-vehicle crash in Pittsburgh
- Proposed 8-story apartment complex called too tall in North Side’s Garden Theater area
- Allegheny RAD executive director moving on after 2 decades
- Peduto pushes for affordable housing in East Liberty redevelopment
- 2 men wounded in Hill District drive-by shooting
- Deadly snake bites on the rise in Western Pa.
- Derry boy recovering at home after high-profile intestinal transplant
- School credit ratings a problem for several in Western Pennsylvania
- Judge adds 2 years to sentence of Baldwin Borough man acquitted of murder
- McKees Rocks teen set for preliminary hearing on homicide, weapons charges