Highmark Inc. customers who subscribe to the health insurance company's new Community Blue product are getting their walking papers from UPMC, starting today.
UPMC said it has been preparing Highmark customers for this possibility, but Highmark said that the "firing of patients is unacceptable and unethical" and that it has referred the matter to various state agencies.
Community Blue -- a lower-cost, select-network coverage plan that excludes most UPMC facilities and physicians -- officially launched Jan. 1.
Not long after, UPMC began sending letters to Community Blue enrollees who have UPMC physicians, telling the recipients 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."
UPMC said it is within its rights to treat which customers it wishes to, and noted that it was Highmark that purposefully assembled a provider network as part of its bid to compete with UPMC, to drive down health care costs and to steer patients to particular hospitals.
Highmark countered that a patient's insurance card shouldn't matter, as long as he or she is willing to pay the out-of-network rates. Highmark added that UPMC gets paid the same either way, since the two health care organizations have a reimbursement schedule in place that dictates the rates and fees Highmark pays for UPMC services.
It's not unusual for doctors, especially primary care physicians, to see patients who are considered out-of-network. In those cases, patients are responsible for a higher co-payment, higher co-insurance and the remaining balance of the physician-billed charges after the insurer picks up part of the tab.
Highmark also noted that UPMC will take cash payments from other out-of-network customers -- out-of-town patients who need a transplant are one such example -- but are essentially discriminating against Community Blue subscribers.
"These patients have not been fired or turned away because they were not willing to pay for their care, or because their insurance did not fully pay for the services. They were denied simply because of the type of insurance coverage they maintain," said Highmark spokeswoman Kristin Ash. "These actions [are] a further example of UPMC desperately scheming to promote a business monopoly, rather than focusing on patient care."
UPMC spokesman Paul Wood said Highmark is the one that's desperate. "Highmark told the [Pennsylvania Department of Insurance] is its most recent filing that it expected to have 200,000 Community Blue members by January 2013. Community Blue is failing dismally in the market, as no one wants an insurance product without UPMC."
Highmark said it has tens of thousands of Community Blue customers so far, but will not provide the specific number. Many of those customers are Highmark employees.
Last autumn, shortly after Highmark unveiled the details of its Community Blue product, UPMC warned customers in an online forum that "Community Blue patients will not be accepted by [UPMC] hospitals, facilities or physicians," except for those facilities already built into the Community Blue network. Those facilities are Children's Hospital of Pittsburgh, UPMC Northwest, UPMC Bedford and Western Psychiatric Institute and Clinic.
Highmark said it has notified the state attorney general and the state health and insurance departments of this latest dustup with UPMC.
Bill Toland: email@example.com or 412-263-2625.