Fábregas: Bickering 'couple' at it again
Told you so.
Did I not say last week that it was only a matter of time before UPMC and Highmark started bickering again like a divorced couple? Did I not cast doubt about the notion that UPMC and Highmark will live happily ever after?
They're at it again, this time over the terms of the so-called agreement Gov. Tom Corbett announced just a few weeks ago.
If you recall, the agreement would allow Highmark members to use UPMC emergency rooms, cancer services and even get treatment from some UPMC doctors. That's what we've been told in recent Highmark-sponsored advertisements, and that's what I wrote last week.
What the ads won't tell you is that, once stabilized at a UPMC emergency room, those Highmark members would potentially be transferred to other hospitals that, unlike UPMC, are considered in-network. By the same token, patients could be admitted to UPMC but would be forced to pay more expensive out-of-network rates, as I indicated last week.
My observations prompted an unexpected yet very compelling email from Mariann Tullius of Wexford.
Tullius, a native Pittsburgher who described her parents as “salt of the Earth,” shared a story about her late mother, Elizabeth “Betty” Butela of Shaler. As much as I've heard every imaginable story about Highmark and UPMC, this one had a twist I had not entirely considered.
Butela, a former nurse who spent her life doing volunteer work, didn't go to a UPMC emergency room. She went to Allegheny General Hospital. But her story clearly illustrates what some emergency patients could be facing in the not-so-distant future. Paramedics took Butela to AGH's emergency department in October 2011. It was the closest hospital when she needed quick treatment for what her family suspected was a stroke. Problem is, Butela had a UPMC Health Plan.
So when doctors stabilized her, Butela's family was told she'd have to be transferred to a UPMC facility because AGH could not take in someone covered by a UPMC plan. The decision was tough to understand for Butela, who had dementia and was growing increasingly confused, Tullius said.
Butela's family pleaded with hospital officials to allow her to stay at AGH. Their answer was no. Driving through a rainstorm in the middle of the night, an ambulance took her to UPMC Presbyterian in Oakland.
Once there, an already exhausted Butela waited hours to be admitted because there was no open room. Doctors ordered tests, similar to what they had done at AGH, to confirm that she'd had a stroke, her daughter told me.
“They don't put the people first,” Tullius said, in reference to an initiative Corbett started called Patients First.
It's not far-fetched to surmise that it's only a matter of time before the same thing that happened to Butela happens to a Highmark member who shows up at a UPMC emergency department. They'll be stabilized and shipped to a hospital that takes Highmark.
“It still makes me angry,” Tullius told me, more than two years after her mom died of another stroke in January 2012. “My mom was 86 years old, she was a wonderful woman. … She was really my best friend.”
No one will talk about the case because of privacy laws. But here's the deal: We're starting a new chapter in Pittsburgh's health care industry. When you choose a health plan, read the fine print. Make sure it gives you the option of going to the hospital you want — not just the emergency room.
Luis Fábregas is Trib Total Media's medical editor. He can be reached at 412-320-7998.
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.
- Crosby says Edmonton would be good spot for prospective top pick McDavid
- Reagan shooter Hinckley closer to permanent freedom
- Fights reported, shots fired outside Monroeville Mall restaurant
- Crosby’s 2 goals lift Penguins past Rangers, even series
- Sutter steps up for Penguins in series-tying victory
- Steelers won’t be backed into a corner at NFL Draft
- Starkey: Taylor’s type fading away
- Rangers’ Miller matures into productive player
- Use of multiple contractors could leave oil, gas operators open to hackers
- Penguins notebook: Johnston says Perron needs to shoot
- Marte jump-starts Pirates in win over Brewers