UPMC, the region's 20-hospital network, is putting a friendly spin on its corporate decision to deny affordable access to Highmark customers. But there's nothing friendly about it -- not for Joel Vanucci of Beechview, a retired high school counselor, or anyone else with Highmark insurance.
Joel's health coverage comes from a Highmark plan provided by the Keystone Oaks School District for its employees and retirees. He pays $932 a month for a policy that covers him and his wife and that, for now, gives him the lower rates of network access to UPMC doctors and facilities that have been key to maintaining his health.
While his wife has been generally healthy, Joel, 60, has had both hips and knees replaced, with surgeries at Mercy, Shadyside and St. Margaret's -- all UPMC hospitals. In February he was diagnosed with bladder cancer and had surgery along with a "chemo flush" at Mercy. Now he has follow-up appointments every three months.
"The only doctors I know are UPMC," he said. "They've all been excellent, and I'd place my life in their hands." But that association may be coming to an end.
The 10-year service agreement between the region's largest hospital system and the region's largest health insurer expires on June 30. At that point, says UPMC, Highmark's 3 million customers will lose preferred, in-network prices for use of its physicians. A year later the same policyholders will no longer have network access to most UPMC facilities.
The looming disconnect has a lot of people worried. Yet, in a brand of marketing-speak worthy of George Orwell, UPMC puts a sunny face forward on a website called keepyourdoc.com, which features a so-called Patient Care Assurance Plan. UPMC also has hired Patrice King Brown, a retired KDKA-TV news anchor, to cheerfully front a series of television commercials to help the global medical enterprise recover from its self-inflicted PR disaster.
Despite the TV happy talk, real people like Joel are caught in the nets of this business strategy and real people will suffer if UPMC's self-proclaimed "Life Changing Medicine" is lost in the disruption.
Joel spent a career in education, first as a teacher and coach in the Clairton School District and ultimately as a guidance counselor at Keystone Oaks High School, where he retired in 2008.
Even after 31 years of work with students, he wasn't ready to put away his grade book. Today he heads Project Succeed, a program funded by foundations and school districts to lure high school dropouts and students having difficulty in their home schools back to the classroom to get their diplomas. He has six paid employees, does the fund-raising himself and has 62 students enrolled in evening classes.
Joel's Highmark policy has helped him stay well with UPMC medical care, but he doesn't feel he can switch because this is the health plan provided by his former employer.
"This impasse is affecting millions of people," he said. "To ask them to give up doctors that they have felt comfortable with for a good amount of time is not right. You're affecting people's lives and welfare.
"I look at the TV commercials, and it's like an advertising war. UPMC says Medicare, Medicaid and CHIP patients will continue to be covered. So why not the same courtesy for other people with Highmark insurance?"
Joel tried to contact a few of the civic leaders on the UPMC board of directors and describe his predicament. He left a voicemail at the office of Mark Nordenberg, chancellor of the University of Pittsburgh, where Joel earned master's degrees in health and physical education plus a superintendent's certificate. He did not get a reply. Two other board members did not return his calls either.
The former guidance counselor is like many other Highmark customers who can't figure out why two rich charities -- Highmark with $462 million in profits last year and UPMC with $406 million -- can't just renew their agreement and why UPMC doesn't even want to talk about it.
"There has to be a compromise between these giant nonprofits," he said. "There just has to be."