UPMC preserves access to Hillman Cancer Center for all Highmark-insured patients
Days before a Commonwealth Court showdown against Pennsylvania Attorney General Josh Shapiro, UPMC announced Thursday that it will preserve access at in-network rates for Highmark-insured patients who seek oncology care from Hillman Cancer Center’s 60 locations across Western Pennsylvania and Ohio.
The decision applies not only to seniors and people with disabilities on Medicare Advantage plans but also to younger patients in commercial markets. It applies to patients seeking oncology treatment and follow-up care at the Hillman Cancer Center’s flagship facility at UPMC Shadyside and dozens of community-based locations.
As recently as Wednesday, Highmark-insured patients had been preparing to lose access to UPMC cancer doctors or confront a controversial prepay-in-full rule set to take effect on July 1. UPMC Shadyside is among 10 hospitals in Western Pennsylvania set to go out of network for Highmark commercial members on June 30, when a state-brokered 2014 agreement between UPMC and Highmark is set to expire.
UPMC officials attributed the decision to a spate of calls from Highmark insurance members as well as productive talks during a Thursday morning meeting among UPMC CEO and President Jeffrey Romoff, Allegheny County Executive Rich Fitzgerald and Pittsburgh Mayor Bill Peduto.
“We look forward to continuing these productive conversations and improving access to health care here in the Pittsburgh region,” Peduto and Fitzgerald said in a joint statement.
UPMC also reiterated in a news release and on its website prior commitments to preserving access at in-network rates to Western Psychiatric Institute and UPMC Children’s Hospital of Pittsburgh. On Wednesday, UPMC said it would drop the prepay requirement for more than 100,000 of Highmark’s Medicare Advantage insurance members.
Legal war rages on
Shapiro said Thursday that he’s “glad UPMC has final
But Shapiro dismissed UPMC’s moves as a “coordinated, last-minute ploy” that UPMC could rescind at any time.
He criticized UPMC for choosi
“Schoolchildren, seniors, work
Shapiro filed a far-reaching legal petition against UPMC in early February in which he accused UPMC — Pennsylvania’s largest employer outside government — of breaching its duties as a purely public charity while benefiting from hundreds of millions of dollars in tax breaks. Among other demands, he seeks to require UPMC to contract with any interested insurer “in perpetuity” and replace a majority of its board.
UPMC has accused Shapiro of overstepping his authority in a politically charged quest to reshape how health care works and siding with the interests of its rival Highmark over the public good.
A non-jury trial in Commonwealth Court set to begin Monday in Harrisburg will decide whether Shapiro can extend or halt the June 30 split of the two Pittsburgh-based rivals.
“UPMC, Highmark and the Pennsylvania Attorney General – who has jurisdiction over all charitable, nonprofit organizations – are in litigation, and everything needs to be reviewed by the Attorney General,” Highmark spokesman Aaron Billger said. “We look forward to working with the Attorney General and UPMC, if UPMC is willing to work in good faith.”
Patients still left out
Patient advocates lauded UPMC’s relaxed prepay rules but said that the looming UPMC-Highmark split still is threatening to impact tens of thousands of patients.
The prepay-in-full policy still will apply to employer-insured and younger patients of Highmark who seek nonemergency care at most UPMC hospitals after July 1.
“Many people have lost access already, and there are still people who are getting treatment and specialty care at UPMC Magee-Womens, at UPMC St. Margaret hospital, the eye and ear center, all the other hospitals where people have connections and don’t want to leave,” said Erin Ninehouser, spokeswoman for the advocacy group Pennsylvania Health Access Network.
“There’s a lot of unanswered questions,” Ninehouser said. “Patients need a contract, guaranteed, affordable access, not just a press release.”
Evie Bodick was one of the first patients Ninehouser called to notify of UPMC no longer requiring prepay for patients like her on Highmark’s Medicare Advantage Freedom Blue plan.
Just last week, Bodick, 74, of Springdale finished saying goodbye to her fifth UPMC doctor, her cardiologist, after already having said farewell and having what she lamented would be her last apointmentts with her “lung surgeon, PCP, breathing doctor and cancer doctor.”
“It was heartbreaking,” Bodick recalled by phone Thursday.
She’s still trying to ensure she can keep her doctors, as she’d already lined up five alternates within Highmark’s Allegheny Health Network.
Of UPMC’s latest announcements, “it’s a start,” Bodick said. “I’m really happy for the people who go to Hillman. … But it’s not enough. We’ve got to keep fighting. I’m not just speaking out for me. I’ve been speaking out on behalf of so many people.”
Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .