Higher costs might force expectant mothers with Highmark insurance to bypass Magee-Womens Hospital if the insurer’s contract with UPMC expires next year, and two area obstetricians say that could put a strain on the insurer’s Allegheny Health Network.
Under the transition plan taking shape in Harrisburg this week, perhaps the foremost implication of remaining with Highmark insurance is the likely absence of Magee-Womens Hospital from Highmark’s commercial health insurance network after Jan. 1.
Long the region’s pre-eminent center for obstetrical deliveries, Magee delivers 11,000 babies every year.
The in-network, discounted cost to patients is determined by the insurer’s contract with the provider. Out of network, an uncomplicated vaginal delivery may run $8,000 to $10,000, and cesarean deliveries even more, which some Highmark subscribers are bound to find prohibitive.
One question, then, is whether Highmark’s Allegheny Health Network would be able to handle the additional volume at its obstetrical programs — located locally at West Penn Hospital in Bloomfield and Forbes Hospital in Monroeville, with Jefferson in Jefferson Hills opening an obstetrical program in the fall.
Allegheny Health says it can.
“AHN is fully capable of meeting the complete obstetrical needs of women in the Pittsburgh region who seek care within our system,” said Dan Laurent, spokesman for Allegheny Health. “We have both the capacity to care for more women and, most importantly, capabilities that are every bit as sophisticated as those found at Magee for the care of women and infants.”
But two local obstetricians question that assessment.
“I think this is one area where they’re going to be tripped up,” said Dean Pollack, an independent obstetrician in Shadyside who delivers at both West Penn and Magee.
Mr. Laurent pointed out that obstetrical delivery programs at independent hospitals such as St. Clair Hospital in Mt. Lebanon would carry some of the load and “when you combine our resources, the capacity is certainly there to absorb volume from Magee.”
But Dr. Pollack countered that if just 25 percent of the 11,000 babies Magee delivers move to AHN obstetrical flagship West Penn, the hospital would be nearly doubling its current volume of annual deliveries.
Dr. Pollack said the West Penn program is good, and even praised its neonatal intensive care unit as “the best in the city,” but he believes the number of newborns will still overwhelm the hospital at times. Obstetrical deliveries do not come at a predictable or steady pace, he noted.
“One day you’ll have five and the next day you have 30. And when you have 30, you don’t have the room,” he said. “They do not have the facilities and they do not have the staff to accommodate that.” Nor does he think that Forbes and the new program at Jefferson will be enough to care for the local overflow.
John Gallagher, an obstetrician-gynecologist in Sharon, Mercer County, also said currently “there’s no way [AHN] could handle” the bigger caseload of expectant mothers delivering at their facilities. “How much they could ramp that up, I’m not sure.”
The pending Highmark-UPMC separation carries its own complications for outlying areas, said Dr. Gallagher. It’s not an issue for low-risk pregnancies or the comparatively small numbers of higher-risk pregnancies that come to Pittsburgh. Allegheny Health’s Saint Vincent Hospital in Erie does provide obstetrical services.
Locally, the programs at Magee and West Penn are both well regarded, he said, but many physicians prefer one or the other and have developed strong working relationships. He estimates that Highmark holds a 60 to 80 percent market share in Sharon, making referrals to Magee after this year more complicated.
He added that Sharon area patients have benefited from UPMC specialists in the area who have been available for consultations.
“The outreach has been wonderful, and so that will be lost,” Dr. Gallagher said.
Steve Twedt: firstname.lastname@example.org or 412-263-1963.