As UPMC and Highmark split, patients agonize over having to switch doctors
A New Kensington man may have to say goodbye to his neurologist at an upcoming appointment after being under his care for roughly 25 years.
Jack Swanger, 65, was diagnosed with multiple sclerosis in 1991 at age 37 when he experienced double vision while on the job as a heavy-machine operator.
“For a while, I would just close one eye and I could see fine,” he said.
Following a few years of appointments and tests, Swanger found a UPMC neurologist, Dr. Rock Heyman, who specializes in MS. Over the years, he has grown close to his doctor.
“Rock is like family now,” Swanger said.
Swanger said he wouldn’t need to part ways with Heyman if UPMC decides to extend a consent decree that is set to expire June 30.
The deadline means the health care provider will no longer accept his Highmark insurance plan that his former employer’s union, International Union of Operating Engineers Local 66, continues to provide after retirement.
UPMC declined to comment for this story.
Multiple sclerosis is an incurable disease that affects the central nervous system.
The symptoms take on many different forms, according to the National Multiple Sclerosis Society. The most common symptoms include fatigue, visual impairments, altered sensation and mobility difficulties. The organization also states the disease comes in multiple degrees of severity.
Swanger considers his affliction to be mild. Nevertheless, it has progressed over the years to the point that it affects his balance and mobility and he experiences mood swings, for which he takes an anti-depressant.
He said his ability to reason is a little off, too. Swanger walks with a cane and wears a foot extender to keep his “dropped foot” from dragging. Without it, he said, he would fall over.
Swanger was forced to retire early because of safety concerns related to his imbalance, he said.
His wife, Kathy Swanger, 63, has always taken care of medical bills and other household administrative tasks because her husband has always taken care of household maintenance.
She said the couple is grateful for Jack Swanger’s Highmark Medicare Advantage Freedom Blue PPO plan because it’s affordable — about $600 per quarter.
“We are very blessed,” she said.
Jack Swanger needs to see Heyman once a year. He receives an MRI every two years to track how the disease has progressed.
He fears, however, those yearly checkups will end after his April 29 appointment.
“I recommend him to everyone I meet that is dealing with MS,” Jack Swanger said. “He’s the best.”
Patient to lose doctor July 1
The Swangers join thousands of people who, come July 1, will need to find different, in-network doctors or go through a prepayment requirement if they want to continue treatment at most UPMC facilities. A 2014 consent decree between UPMC and Highmark is set to expire June 30, when Swanger’s doctor will become out-of-network.
The Swangers would then have to get a cost estimate and pay for their care in advance, then seek reimbursement from Highmark.
To avoid that, they would need to find a different doctor who accepts UPMC insurance — or switch insurance plans. That’s not an option offered by Swanger’s former employer.
All doctors must still accept traditional Medicare and Medigap plans.
Kathy Swanger said the union has not offered other insurance plans that contract with UPMC.
Swanger’s union, IUOE 66, did not return calls seeking comment.
State Attorney General Josh Shapiro filed a legal challenge Feb. 7 in Commonwealth Court that seeks an injunction to extend the consent decree in perpetuity. Joe Grace, spokesman for the attorney general, said there has been no movement from UPMC since then.
Highmark has said it will work under the terms of Shapiro’s plans.
UPMC has argued that businesses and consumers have had “substantial time to prepare for the end of the UPMC-Highmark relationship in Western Pennsylvania.”
The Swangers’ Plan B
The Swangers are holding out hope that somehow the situation will be solved.
But in case it doesn’t, they have a backup plan.
As an Army veteran, Jack Swanger is allowed to receive care at the VA Pittsburgh Healthcare System — an option that is attractive because Heyman recommended it and his Highmark insurance plan is recognized there.
Kathy Swanger is annoyed by the whole thing.
“How do people like us start over with a new doctor? How do we develop the same rapport?” she said. “(Heyman) knows us so well, we can never have enough time to feel secure with a new doctor now. How do they get away with this?
“Why is it we live in a world where everything boils down to money?”
Dillon Carr is a Tribune-Review staff writer. You can contact Dillon at 412-871-2325, [email protected] or via Twitter .