It’s not true that UPMC has no defenders on its threat to lock 182,000 elderly Highmark customers out of its hospitals next January. It’s just that its defenders are all apparently employed by UPMC.
Here’s what others had to say.
Gov. Tom Wolf called UPMC’s move “unacceptable” and said he would consider legal action.
Rep. Jim Christiana, a Republican from Beaver, said the “devious scare tactics and anti-patient behavior continue, this time at the expense of some of our most vulnerable citizens.”
Rep. Dan Frankel, a Democrat from Squirrel Hill, said his constituents are “tired of being held hostage by the actions of UPMC.”
Sen. Randy Vulakovich, a Republican from Shaler, said UPMC’s conduct “is totally unacceptable and has gone on far too long.”
Sen. Jay Costa, a Democrat from Forest Hills, said “UPMC has broken its promise” and is “now sticking it to our seniors.”
Is this any way for the region’s premier health care system to behave? Not to mention one that professes to be charitable?
The latest dispute between UPMC and Highmark stems from Highmark’s announcement a year ago that it would no longer pay certain “markups” for cancer care given in a hospital outpatient center, rather than a physician’s clinic. Highmark said the higher reimbursements to health care networks were costing the insurer $200 million a year.
UPMC called Highmark’s refusal to pay “an egregious contract violation” and a unilateral change that violates the June 2014 consent decree signed by Highmark and UPMC. The hospital system says the insurance giant owes it $143 million. As retaliation, UPMC told Highmark that seniors with Highmark’s Medicare Advantage policy would be barred from UPMC facilities beginning next year.
You can almost hear the UPMC commercials in next fall’s insurance enrollment season: Afraid of losing your UPMC access? Uncertain about whether you’re covered? [Cue actress in rain holding half-umbrella.] There’s only one way to be sure — enroll in UPMC Health Plan.
Mr. Wolf is right that it’s wrong to wage this contract dispute on the backs of Western Pennsylvania’s older insurance customers.
Under the consent decree, Highmark and UPMC agreed that vulnerable patient groups — children in CHIP, people in Medicaid, those 65 or older eligible for Medicare or covered by Medigap Health plans or Medicare Advantage — would not be affected by changes in their contractual relationship. And it’s refreshing to see a Pennsylvania governor using a loud voice and possibly legal muscle to get tough on the nasty dispute between two billion-dollar corporations that has befuddled and enraged the people of this region.
UPMC doesn’t need to take the elderly hostage over a contract dispute. Like Highmark, it has a battery of smart, high-priced lawyers to negotiate through legal disagreements.
But to threaten to take away the UPMC access of 182,000 seniors, who are not a party to the negotiation, is a bully tactic, pure and simple. Is that the kind of life-changing medicine UPMC is practicing now?
First Published: April 12, 2015, 4:00 a.m.
