Losing UPMC: An ailing young mother tries to buy more time
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As the impasse between Highmark and UPMC persists and a deadline looms for 3 million insurance customers to lose affordable access to the region's largest health care system, Joe and Lisa Hauser are trying to stay upbeat.
That's not easy, considering that Lisa has an inoperable brain tumor. The couple in Bruin, Butler County, are just trying to buy more time, for themselves and their two children, ages 9 and 12.
They've felt confident they can do that with the good care Lisa has received from UPMC doctors and facilities. But what they don't need is the added worry that their in-network access will begin to disappear next year because they are Highmark insurance customers.
UPMC's stated reason for not wanting to continue Highmark customers' preferred-rate access -- to its doctors after June 30 and to most of its hospitals a year later -- is that the insurance company has spent hundreds of millions of dollars to prop up the West Penn Allegheny Health System, a smaller and financially weak competitor. Yet UPMC has been in the business of both health care and health insurance for more than a decade.
The state Legislature is finally getting active on the issue and Gov. Tom Corbett has had conversations with the two giant nonprofits. Last week the House passed a bill that could force binding arbitration on the parties to the dispute, and a day earlier a state Senate committee approved legislation to give the insurance commissioner power to extend a contract between insurer and health care provider by up to three years.
Employers that buy Highmark policies have tried to assure their workers that things will work out, but UPMC's TV commercials tell the public frankly and firmly that Highmark and UPMC will soon part company.
It's an unconscionable predicament for everyday people whose tax dollars and personal donations, along with state-conferred tax exemptions, have fueled the success of UPMC, a $9 billion global enterprise. But maybe the writing was on the wall long before this year.
With UPMC's $4-million-a-year CEO, its executive offices not in a hospital but Downtown in the U.S. Steel Tower, its ubiquitous acronym high atop the 64-story skyscraper, its closing of Braddock hospital in a hard-bitten steel town and its construction of a new medical center in the more prosperous suburb of Monroeville, not far from an existing hospital -- no one will mistake UPMC chief Jeffrey Romoff and his go-along board of directors for the Sisters of Mercy.
Meanwhile, the anxiety rises for people like Lisa, 33, and Joe, 35, who are caught in the middle. Joe runs a residential program for adults with mental illness. Lisa was a restaurant manager.
In 2010 Lisa was diagnosed with a brain tumor that was removed surgically. Doctors then noticed another suspicious spot which, after monitoring and a biopsy, they diagnosed this past July as inoperable brain cancer. Lisa has had surgery at UPMC Shadyside and 32 treatments of radiation. Now she makes visits to UPMC's Hillman Cancer Center while on a 52-week regimen of oral chemotherapy. The family's Highmark health plan is a group policy purchased by Joe's employer, the Irene Stacy Community Mental Health Center. Why doesn't he look for coverage that would ensure continued affordable access to UPMC?
"It's intimidating to seek your own health insurance," he said. "It's costly for an individual, and I'm already paying 10 percent of the premium on my group plan. Plus, with Lisa's pre-existing condition you almost feel trapped."
The couple believe they have gotten the best care possible from UPMC's doctors and nurses. "A doctor at Duke University Medical Center said the facility we're at is where we should be," Joe said. "I don't want to change that." He said UPMC medical personnel have tried to be reassuring about his insurance coverage, "but no one has come forward and said it's all going to work out."
Joe said that, as Lisa battles on, the two of them are trying to focus on her treatment and not UPMC's decision to dump Highmark customers.
"We're looking to accomplish an extension of time," he said. "That's valuable time to us and to our kids.
"My wife is amazingly positive. She told the doctors, 'I don't want to know the prognosis, but I'm gonna make you look good -- because I'm gonna beat this thing.' "
First Published December 20, 2011 12:00 am