Allegheny County Controller Chelsa Wagner listens Monday to testimony during a meeting at Carnegie Library of McKeesport. (Charlotte Hopkins photo special to Tube City Almanac)
Customers are concerned about what will happen when a consent decree between UPMC Health System and Highmark, the area's largest Blue Cross Blue Shield provider, ends on July 1.
At the first of a series of community meetings organized by Allegheny County Controller Chelsa Wagner, held Monday night at Carnegie Library of McKeesport, Highmark subscribers said they were angry about some of UPMC's practices.
Wagner is holding another meeting at 6:30 tonight (Feb. 7) in room B-434 of CCAC South Campus, 1750 Clairton Road, West Mifflin.
Some of the people who spoke Monday asked that their names be withheld. One woman said she has a brain tumor and has been treated by a UPMC doctor even though her insurance is with Highmark. That arrangement will end June 30, when UPMC is no longer required to accept certain Highmark patients.
She told Wagner and other elected officials, including state Sen. Jim Brewster, state Rep. Austin Davis and McKeesport Mayor Michael Cherepko, that she feels like her life is on the line.
“They need to learn to play in the sandbox together,” she said. “This is just petty stuff with money over people's lives.”
One of the biggest problems from the so-called "divorce" between UPMC and Highmark, some patients said Monday, is that doctors and hospitals are being forced to choose only one provider or the other to work with.
A cancer patient told Wagner and the other elected officials that she is being treated for a rare form of the disease. She said that she's a Highmark subscriber, but the only doctor in Pittsburgh who can treat the cancer is exclusively a UPMC provider.
Although Highmark agreed to pay for her treatments, she said, UPMC returned Highmark's payment and instead billed her for the treatment, at an out-of-pocket expense of $2,000.
If no resolution is negotiated between the companies, she said, becoming emotional, she will have to discontinue her treatment.
People will “because they take away the access to the only care that they've been given,” she said.
State officials, including Auditor General Eugene DePasquale, have been pressuring UPMC and Highmark to resolve their differences, and state Attorney General Josh Shapiro on Thursday said he would take legal action to force the two non-profit healthcare providers to work together.
On Wednesday, state Sen. Jay Costa Jr. of Forest Hills said he is seeking co-sponsors for new legislation that would compel UPMC, Highmark and other health care providers to either contract with each other voluntarily for services, or enter mandatory arbitration if they fail to come to an agreement on their own.
“Both parties need to come to the table, negotiate and cultivate a relationship that will allow the residents of Western Pennsylvania to get the care they need,” said Costa, the state Senate's Democratic leader. “It’s time to undo the damage caused by the divorce of these two companies. Disputes between enormous, profitable companies cannot get in the way of patients and their care.”
Besides Wagner and the state officials, City Council President Richard Dellapenna Jr. and City Administrator Tom Maglicco also attended Monday's event.
“These healthcare giants are listening to you, but I think more importantly that our elected leadership is hearing from you,” Wagner told the audience.
Representatives from both Highmark and UPMC were invited to attend the meeting, Wagner said, but no one from either group responded.
Cherepko thanked Wagner for holding the meeting. “As elected officials, I think we all need to be aware of some of the things that are going on so that we can also voice a concern for our residents onto the higher authorities,” he said.
Also in attendance was Erin Ninehouser from the Pennsylvania Health Access Network, a group of consumer advocates based in Philadelphia.
“The bottom line is that these are institutions that every one of us here have supported and so for them to turn around and close their doors and call the shots is not right,” Ninehouser said.
She told the audience that the most powerful tool consumer advocates have when lobbying elected officials for change is “your stories” and asked anyone affected by the changes to contact the group via its website.
State and federal lawmakers have introduced two pieces of legislation designed to protect consumers, said participants in Monday's meeting. One, the “Surprise Medical Bill Act,” would stop patients from being billed for treatments that should have been covered by the insurance companies.
The other, called the “Any Willing Provider Act,” would allow patients to be seen by any doctor of their choice.
Other upcoming meetings being convened by Wagner include:
3 p.m. Feb. 10, Northland Public Library, 300 Cumberland Road, McCandless
6 p.m. Feb. 12, Kingsley Association, 6435 Frankstown Ave., Larimer (Pittsburgh)
6 p.m. Feb. 18, Coraopolis Borough Building, 1301 Fourth Ave.
Additional information --- including a petition --- is available on Wagner's website at HealthcarePGH.com.
Charlotte Hopkins is a freelance writer from West Elizabeth and was one of the hosts of the Mon Valley Author Expo. She can be reached at email@example.com. Editor Jason Togyer contributed to this story. He may be reached at firstname.lastname@example.org.
Originally published February 07, 2019.