UPMC gives Blue enrollees more time

New clients have 'transition' window


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The tens of thousands of new enrollees to Highmark's Community Blue insurance plan still won't have full access to UPMC's doctors and hospitals this year -- but some of them will at least have additional time to meet with their UPMC doctors to smooth the "transition of care."

It's a departure from how things worked a year ago after the relaunch of Community Blue, a health plan that doesn't fully include UPMC among its "in-network" providers.

Last year, new Community Blue enrollees who had been patients at UPMC practices received letters in February telling them that as "a result of Highmark's exclusion, [we regretfully] inform you that you need to arrange for care by another physician. ... Effective March 2, 2013, you will no longer be an active patient at the practice noted above."

Some patients were upset because they didn't realize that UPMC was out-of-network for the Community Blue plan; more were angry that UPMC wouldn't see Community Blue patients even if they agreed to pay out-of-network charges or cash.

But this year, new enrollees will have until March 31 to see their former UPMC doctors and specialists, according to an email circulated to UPMC physicians and clinics. Still, enrollees will be subject to out-of-network charges that will count toward their deductibles, should they choose to keep the appointments.

"Certain appointments will not be canceled for new Community Blue subscribers," the UPMC email says, as long as the subscriber has been treated by UPMC within the past three years, and as long as the appointment was made before Dec. 31. Also, those who were Community Blue members in 2013 will be able to have one last "transition of care" appointment, if they haven't had one already.

Obstetrics patients also may be granted access to UPMC facilities "until at least eight weeks post-partum."

Whatever the circumstance, Community Blue enrollees should call Highmark "to understand their potential liability for care at out-of-network UPMC providers," the UPMC memo said.

The extra time is being given this year, said UPMC spokesman Paul Wood, because so many buyers of Community Blue still aren't aware that the product excludes most UPMC hospitals.

"Far too many patients were coming to us who didn't know," he said. "We will see them through the end of March [so they can] get off on the right step" with their new doctors.

There figure to be several thousand new Community Blue customers this year -- the product has been popular among those buying policies through HealthCare,gov, the website that acts as the online health insurance "exchange" where those in need of insurance can buy individual and family plans.

Through Jan. 1, Highmark sold 37,132 policies via the exchange, which launched Oct. 1, a key component of the 2010 health care overhaul law known as the Affordable Care Act. Most of the policies sold -- more than 80 percent -- were Community Blue plans, according to Highmark. (January enrollment figures weren't available.)

A Highmark spokeswoman said that UPMC's stance is good news for Community Blue customers.

"UPMC is finally starting to recognize the needs of patients and put patients first, which is something we asked for last year when they first started denying care to Community Blue members," Kristin Ash said. "Continuity of care is important, and we appreciate the fact that UPMC is putting the interests of patients first and doing the right thing for Western Pennsylvania residents."

Although Community Blue omits from its network most UPMC physicians and Pittsburgh hospitals, Children's Hospital, UPMC Northwest, UPMC Bedford Memorial, Western Psychiatric and UPMC Altoona and many oncology services are part of the network.

Highmark markets the plan as lower-cost option because it excludes UPMC's higher-priced hospitals. Its regional network includes 50 hospitals and 7,600 physicians and specialists.

All Highmark plans might resemble Community Blue in 2015, if Highmark and UPMC can't arrive at a deal that extends or renews the reimbursement contract between the two Pittsburgh health giants.

Bill Toland: btoland@post-gazette.com or 412-263-2625.


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