Out-of-state health insurance no safeguard for Pittsburgh couple

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Angela Vennare-Klein and husband Dennis Klein of Beechview didn't figure to get caught in the crossfire in the war of words between Pittsburgh health giants Highmark and UPMC. They felt safe because they have health insurance through her employer in North Carolina, which has an office in South Oakland.

"Our insurance is Blue Cross Blue Shield of North Carolina," Ms. Vennare-Klein said. "You would think we would be in the clear because North Carolina has nothing to do with what's going on here."

It was last spring when Ms. Vennare-Klein noticed the small type on an insurance form stating that Highmark administers her health plan. Curious, she called her employer's human resources department in North Carolina to find out what that meant.

It took a few weeks, but the response has sent chills through the couple's household.

As members of a plan administered by Highmark, her family is considered part of the insurer's group just as, by Highmark's estimate, 275,000 other local residents are who have coverage from another Blue plan but use Highmark's provider network.

UPMC is threatening to push Highmark's members out of its network when their current contract ends Dec. 31 because Highmark is building its own provider network. Highmark has said repeatedly that it wants to negotiate a new contract with UPMC.

"I thought, 'No, that can't be.' But, even though we're in North Carolina, we're lumped in with the rest of them," said Ms. Vennare-Klein.

The couple's fear -- and that's the word they use -- is founded on their extensive medical histories. Five years ago, Ms. Vennare-Klein, 55, was diagnosed with Stage IV non-Hodgkin's lymphoma. Although now in remission, a recent checkup at UPMC Mercy showed spots on both sides of her abdomen that she expects will eventually mean more chemotherapy.

Mr. Klein, 58, is on disability and only works part time as a shuttle driver after being diagnosed with acromegaly, a rare growth hormone disorder that requires regular medical care by a specialist. His physician, too, is at UPMC Mercy.

"Both of us are going to have to be ongoing with specialists for the rest of our lives," Mr. Klein said.

Unlike local Highmark members, the Klein family -- which includes two college-age daughters -- does not have the option of switching to UPMC Health Plan or one of the national insurers that now contract with UPMC. Her employer, she said, offers only the North Carolina Blue Cross Blue Shield Plan.

"I have no control over this. That's what frightens me. We're talking about serious, ongoing, life-threatening stuff," Ms. Vennare-Klein said. "You don't want to change doctors in mid-stream."

UPMC spokesman Paul Wood says UPMC "would be happy to contract directly with North Carolina BC/BS for in-network access to UPMC," but that seems very unlikely as Blue Cross typically blocks contracting with an out-of-state provider.

Highmark spokesman Aaron Billger said once Highmark members fall out of network, their costs for using UPMC facilities and physicians "would be anywhere up to 70 percent of the out-of-network cost."

Ms. Vennare-Klein, a materials manager for a North Carolina engineering company, has done the math for her family's plan. By her calculations, their annual out-of-pocket medical expenses -- currently about $15,000 -- would grow to more than $20,000.

If it happens, "No more family vacations," she said, "and it will affect everything else in our lives. We don't have a boat, or a condo or a time share. You work hard, you pay your bills and whatever's left, you have some fun. I just want to keep my lifestyle, teach my kids by example and pay my bills."

Despite their anxiety about what's to come, the Kleins say they are not angry at either UPMC or Highmark. They have nothing but praise for their care at UPMC Mercy and noted that both of their daughters have benefitted from the Pittsburgh Promise scholarship program, which UPMC sponsors.

They've also heard good things from friends about the quality of care at Allegheny General Hospital, the flagship of Highmark's Allegheny Health Network, and Ms. Vennare-Klein volunteers for the Highmark-sponsored "Healing Journey" leukemia group.

But they also don't give the two health care entities a free pass.

"There's good and bad, and right and wrong, on both sides," Ms. Vennare-Klein said. "We have this wonderful care and research, with people coming from all over the world. Then you have this other part that has this Wall Street greed.

"It's sad. I think health care was the last bastion for putting people first, and now even that is succumbing to greed."

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

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