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Fábregas: Bickering 'couple' at it again

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Saturday, July 19, 2014, 12:01 a.m.

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.

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