UPMC proposes payback plan for Highmark's Community Blue subscribers

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UPMC officials Monday offered what they described as "a solution to address concerns that have been raised about Highmark's Community Blue product."

The solution? Let UPMC bill Community Blue subscribers the full out-of-network rate, then have Highmark reimburse the subscribers directly. But Highmark spokeswoman Kristin Ash said Monday that UPMC's "solution" is no solution at all.

UPMC chief legal officer W. Thomas McGough Jr. made the proposal in a letter to state legislators who had organized a hearing about Community Blue subscribers losing access to UPMC physicians and facilities.

Community Blue is a lower-cost insurance product, but it achieves savings, in part, by writing most UPMC hospitals out of its roster of "in-network" facilities. After the Jan. 1 launch of Community Blue, UPMC clinics began sending letters to Highmark patients, telling them that if they had Community Blue coverage, they would no longer be welcome at UPMC clinics.

Mr. McGough said the impediment to a solution has been Highmark's prohibition of UPMC so-called "balance billing" Community Blue subscribers.

"Under this proposal, UPMC will employ the well-established reimbursement method used by every other insurer and health care provider: UPMC would determine the out-of-network charges to be billed directly to the Community Blue subscriber and Highmark would determine the amount it will reimburse to the subscriber."

Ms. Ash said UPMC agreed last year, as part of the contract extension brokered by Gov. Tom Corbett, not to balance bill Highmark subscribers, "so it would require a contract amendment" to change that.

Highmark insisted on the "no balance billing" provision "to protect members from paying exorbitant out-of-network charges that are determined by UPMC," she said.

Highmark will review the proposal and discuss it with UPMC, she added, "but at first glance it continues to look like they're putting profits above patients." The House Democratic Policy Committee, led by state Reps. Dan Frankel, D-Squirrel Hill, and Tony DeLuca, D-Penn Hills, organized a public hearing Downtown on Monday to hear testimony regarding the Community Blue issue.

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Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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