Springdale woman moved by reunion with UPMC doctors she thought she’d never see again
Six weeks ago, Evie Bodick had just about given up.
The 75-year-old Springdale woman broke into tears in mid-June when she recounted that she had to shift her health care treatment away from the doctors and facilities she’d trusted for years, all because of a bitter battle between Pittsburgh’s two competing health systems, UPMC and Highmark.
Physically exhausted and mentally drained after months of fighting to keep them, Bodick reluctantly parted ways with five UPMC physicians she credited with saving her life. The recovering cancer patient, who also deals with heart and lung issues and diabetes, felt her eyes well up each time she hugged one goodbye.
Her head hurt from navigating conflicting messages about her coverage and her heart felt heavy at the mere thought that because she had a Highmark Medicare Advantage insurance plan, she was going to be shut out from most UPMC facilities — including UPMC St. Margaret, which she frequented.
Last week, Bodick teared up again — only this time out of sheer happiness, gratitude and relief that she won’t have to say goodbye to the doctors she adores.
On Wednesday, Bodick reunited with Dr. Jason Lamb, a cardiothoracic surgeon affiliated with UPMC’s Hillman Cancer Center and UPMC St. Margaret.
“He was so happy to see me. It was wonderful to see him. He was all smiles,” Bodick, who has a Freedom Blue Medicare Advantage plan, said shortly after her appointment at the UPMC Natrona Heights cancer center. “To get to be with him again is like a miracle to me. We are like family with him and his staff, and it’s like going home when you haven’t visited your family in a long time.”
Her husband, Joe, said his wife’s mood has improved since UPMC and Highmark in June announced a 10-year agreement.
The deal will preserve access to doctors in both systems for more than 1 million Highmark-insured patients, including commercial PPO plans and Medicare Advantage Freedom and Security Blue plans.
“To me, it’s like Christmas in July,” he said. “It makes her so happy, and if she’s happy, you know, I’m a happy guy. It’s a great feeling.”
The unexpected truce happened after months of heated litigation and just six days before UPMC and Highmark were poised to split networks. That would have forced Highmark-insured patients to prepay in full for non-emergency care at most UPMC facilities.
“It should have happened sooner,” said Bodick, who knows many people who were displeased that they switched plans on the premise of the impending split and controversial prepay rule that was dropped with the deal. “They shouldn’t have waited so long to do this.”
State Attorney General Josh Shapiro, who took legal action against UPMC in February in his quest to force a compromise between the behemoths, lauded the leaders of UPMC and Highmark for inking an agreement to preserve access to both health systems for the majority of patients across a 29-county region.
‘One of the lucky ones’
Not all patients stand to benefit from the 10-year deal.
The privately negotiated contract, which has not been made public, is broad in that it applies not only to Medicare-eligible and cancer patients but to patients of every age and those on individual as well as employer-based plans.
That is, as long as they are enrolled in so-called “broad-based” plans, or plans that include at least partial benefits to other networks.
Highmark also agreed not to charge patients more for care received at UPMC facilities than it does for care within Highmark’s Allegheny Health Network.
But, also under the new contract, UPMC and Highmark agreed each has the right to continue rolling out narrow or exclusive network plans that specifically exclude the other. Employees from UPMC and Highmark are on such plans and will not have in-network access to the other.
An estimated 1.2 million patients will be able to access both UPMC and Highmark’s Allegheny Health Network under the contract.
An additional 300,000 or so people with Highmark plans will not.
Hundreds of thousands more patients with narrow-network UPMC plans similarly will not have access to AHN facilities, except for Jefferson Hospital and St. Vincent Hospital in Erie.
“Even though I’m happy of what happened, there’s a lot of people who are angry, and I understand,” Bodick said. “I’m one of the lucky ones.”
Others not so lucky
Some employers, including teachers unions, have chosen narrow-network plan offerings because those tend to cost less.
Among those not being helped by the UPMC-Highmark deal is Nancy Myers, who lives in Sharpsburg and works for the Fox Chapel Area School District, where her only option was a Community Blue insurance plan.
“It’s not only me, it’s my whole district,” she said. “I don’t have a choice in this; it’s dictated.”
The day the deal was announced, a health office worker told her that she could continuing going there and possibly book a July 10 appointment. Two days later, someone called back to tell her she would not to be able to do so because she fell into the out-of-network group.
“It was a joke, everybody was celebrating, and then they tell us, ‘No, it’s not you,’ ” she said. “It’s not a celebration. It’s a slap in the face, that’s what it is.”
Myers has spent more than a dozen hours on the phone trying to figure out what it might cost her and her husband to continue visiting UPMC’s Heart & Vascular Institute at UPMC Shadyside. Her husband had been seeing doctors there as recently as late June.
It’s unclear just how much more UPMC or Allegheny Health Network hospitals and doctors might charge for out-of-network patients on narrow-network plans.
Highmark officials have said they do not anticipate UPMC trying to force prepayments in full.
“It’s tearing me up mentally,” Myers said. “Highmark points the finger at UPMC and UPMC points the finger at Highmark, and all the people who make millions of dollars don’t seem to care that there are people that are depending on these doctors for their lives.”
Broader quest for access
Shapiro said he met with a group of Pittsburgh-area employers and is hopeful more employers will decide to offer broad-based plans or at least give employees the option to choose one with access to both UPMC and Highmark.
Exceptions that will accept patients no matter their insurance card include UPMC Children’s Hospital of Pittsburgh and Western Psychiatric Hospital.
Despite a pledge from UPMC to provide access to everyone at all 60 Hillman Cancer Center locations, Highmark’s narrow-network plans do not provide access to those cancer centers in the greater Pittsburgh area.
Bodick not only worried about losing access but spent the past several months advocating for patients in the region.
She wrote and called lawmakers and made several trips to Harrisburg to convey to them in person the desperation and frustration confronting patients like her.
She hugged and thanked Shapiro in person when he paid a visit to a few dozen patients and advocates last month.
“I still have a hard time believing it’s true that we really did it,” Bodick said. “It was worth all the fight and the traveling and the letter writing and everything, and I’m so happy for the people that it will help.”
Bodick said the fight won’t be over until everyone can access hospitals of their choice.
“I feel what we did was a temporary fix,” Bodick said. “Ten years is going to go by fast, and I’m worried about my kids, my grandkids.”
Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .