Transplant patients in limbo over coverage under UPMC-Highmark pact
Transplant patients caught in the middle of the UPMC-Highmark battle say a four-week-old agreement between the rivals is confusing, and some fear they will have to switch hospitals.
“It's terrible. I've been asking questions for two years, and they keep telling me they don't know. They just totally ignore you. The transplant people are being held hostage because they can't get an answer,” said heart transplant recipient Jim Killinger, 68, of Uniontown.
The retired state police officer, who received a new heart in 2007 at UPMC and has Highmark insurance, wants to know whether he can continue getting care at UPMC. A commercial contract between UPMC and Highmark expires in December and will not be renewed.
An agreement announced in late June by Gov. Tom Corbett and Attorney General Kathleen Kane indicates that Highmark members in the middle of treatment at UPMC will be able to stay at UPMC at the same in-network rates. The agreement says such an arrangement would prevail as long as patients and their doctors deem it necessary.
Yet almost four weeks after the deal was announced, some organ transplant patients say they find themselves with little information. They worry where they will get post-transplant care and who will monitor their complex regimen of anti-rejection medications.
“We're really concerned,” said Mary McConville of Leechburg, whose daughter received a kidney transplant at UPMC. “She's so used to her doctors at UPMC. Is she going to be shifted over?”
Spokesmen for both Highmark and UPMC said on Wednesday that patients who are in the midst of treatment will not have to change hospitals or doctors. They supplied answers about Killinger's case only after inquiries from the Tribune-Review.
“Inevitably, we're going to have some challenges explaining the mechanics of the transition,” Pennsylvania Insurance Commissioner Michael Consedine told the Trib. “With 3 million people in Western Pennsylvania, you have 3 million possible hypotheticals.”
Highmark spokesman Aaron Billger said a customer service representative last week gave Killinger details of the agreement, which came about after months of sparring between the insurer and UPMC.
“It's up to the doctor and the patient,” Billger said about Killinger's coverage. “If his doctor agrees to see him, Highmark will pay in-network rates.”
Killinger said he received what looked like a form letter from the insurer that failed to provide a simple answer. He said he asked his transplant coordinator as recently as Tuesday what to do, and she told him she had not heard anything on the matter.
In response to questions from the Trib, UPMC spokesman Paul Wood said Killinger would be able to continue treatment at UPMC.
Wood acknowledged that UPMC front-line workers might not be familiar with the Highmark agreement because it is only a few weeks old.
“There are a lot of things to be sorted out. One of them is making sure the issues are properly communicated,” Wood said.
In addition to organ recipients, Highmark members on the UPMC transplant waiting list are considered to be in the course of treatment, Wood and Billger said. Should a donor materialize, those patients will be able to get a transplant at UPMC, he said.
More than 10,000 patients have received organ transplants at UPMC since 1988, according to the United Network for Organ Sharing.
A transplant center based at Allegheny General Hospital in the North Side would be able to accommodate people insured by Highmark plans once the insurer's contract with UPMC expires. AGH spokesman Dan Laurent said the center has received no inquiries from UPMC patients looking to transfer their care.
Killinger said he wants to stay at UPMC Presbyterian, where he has received care for about seven years. He wants to maintain his health insurance, supplied by the Pennsylvania State Police, from which he retired in 1999.
If he changes insurance carriers, he would have to pay for it himself. He said he visits UPMC's clinic a few times a year for follow-up treatment and monitoring of his anti-rejection medicine.
“I'm doing fine. I feel good. But I feel like I'm in limbo,” he said.
Luis Fábregas is Trib Total Media's medical editor. He can be reached at 412-320-7998 or firstname.lastname@example.org.