UPMC Saga Continues... (credit, broker, buying)

[LIRefugee]

Originally Posted by Bong477

I have upmc hmo advantage. Not sure if this is specific to the office or a wider reaching policy, but I was turned away despite my willingness to be cash pay. I bumped it up the chain of command but got the same answer. I was like Wtf no wonder you are going out of business.

When was this? WPAHC would not be doing themselves any favors by engaging in tit-for-tat tactics with UPMC.

[Bong477]

Will be 2 years in July or August. This was prior to community blue hub bub. Have stuck with upmc since. We wanted to reestablish with this doctor when we moved back to Pittsburgh but couldn't.

Some employers offer different insurance options, some don't.

[Hopes]

Originally Posted by juliegt

If you have a pre-existing condition (which is basically sneezing anytime in your life) it is next to impossible to change insurers outside what your company offers - if you're lucky enough to work for a company that offers affordable health care benefits. The pre-existing condition law doesn't change until 2014.

You can easily change insurance providers outside of your employer with preexisting conditions. I've done it many times. Pre-existing conditions applies to lapses of coverage. If you have been continuously insured for a year, pre-existing clauses do not apply when switching insurance programs. I guess many people aren't aware of that. Many employer group policies have pre-existing condition clauses too. We learned that the hard way once. And even though pre-existing condition laws don't change until 2014 (That's just 8 months from now), there is a plan via Highmark called PA Fair Care that doesn't have pre-existing condition clause and costs $360/month. You have to have a lapse of 6 months to qualify for it. Why? Because they don't want people purposely going without insurance and only buying insurance when they are sick. By having a 6 month waiting period, they are covering the people who are truly impacted by pre-existing condition clauses. You can have a 60 day lapse without pre-existing condition clauses applying. Any lapses of coverage between 60 days and a year are applied to the pre-existing time period. Meaning, if you had a three month lapse of insurance, your new insurance's pre-existing condition clause wouldn't cover you for the first three months but will cover you after three months. If you have a lapse of coverage for 12 months, the pre-existing condition clause applies for a whole year. There are other options out there too. I'm the master of pre-existing condition insurance issues due to my health issues.

[Hopes]

Originally Posted by LIRefugee

Not everyone has the wherewithal or financial resources to go to Baltimore at will. If they have Community Blue, they probably are in that boat.

Wherewithall is one thing. I definitely have that. If I were sick enough, I'd sell my house and move closer to John Hopkins. It's that much better of a hospital compared to what's around here. Cleaveland isn't far. And WPAHS is right here in town. Is Community Blue the medical assistance insurance? Nobody is accepting the medical assistance insurance from either health system. It must pay terribly.

[Bong477]

Although this is changing preexisting conditions are covered when you switch policies without a lapse but they still can affect the price of the policy.

[Hopes]

Originally Posted by Bong477

I was turned away despite my willingness to be cash pay. I bumped it up the chain of command but got the same answer. I was like Wtf no wonder you are going out of business.

Next time lie and say you don't have insurance. You'd be amazed the better deals you can have without insurance. I paid $25 for physical therapy appointments when I had a lapse of insurance. Meanwhile, my specialist copay was $30 and $50 when I was insured on some other policies previously. That one left me scratching my head because we're not low income. I didn't even pretend I was. I merely called and asked what the cost would be without insurance. The answer: $25. I was blown away! We have a messed up healthcare system, that's for sure.

[Hopes]

Originally Posted by Bong477

Although this is changing preexisting conditions are covered when you switch policies without a lapse but they still can affect the price of the policy.

That's never happened to me though.

I think many people assume a lot because of what they read in the media and don't even bother shopping around.

[LIRefugee]

Originally Posted by Hopes

Many employers offer other options. Employers for my husband and me both have for the past 20 years. We have never taken UPMC option. We haven't had Highmark since the early 90s. We've had great coverage via United Healthcare, Health America, CIGNA and a few others. The problem is that many people buy the cheapest option available from their employer. They pay dearly by choosing the UPMC or Highmark options because of the mess that's going on between the two providers. Plus the cheaper options aren't really cheaper because they have higher out of pocket expenses.

I would agree with thoroughly examining your options is a wise course of action if you actually HAVE options, but for my employer I have a Hobson's choice of one, and I feel lucky my one choice isn't BCBS. I'm a bit of a Pittsburgh oddball employment-wise but I can't imagine my situation is too unusual in the area. Perhaps after 2013 ends I will better be able to shop around and you are correct that there is no reason why I shouldn't.

Too many people choose the cheapest option in many scenarios without fully considering the situation as a whole.

[Clint.]

Originally Posted by Hopes

Is Community Blue the medical assistance insurance? Nobody is accepting the medical assistance insurance from either health system. It must pay terribly.

No, it's a commercial plan.

Ironically, even though the Medical Assistance plans (UPMC for You, Gateway, or even just plain Medical Assistance ACCESS without also being dual eligible for Medicare) have low reimbursement rates all hospital based clinics accept them. I think they are required to accept government plans since they are not-for-profit. Can't say the same is true for independent physician's offices.

[Hopes]

Originally Posted by LIRefugee

...but for my employer I have a Hobson's choice of one, and I feel lucky my one choice isn't BCBS. I'm a bit of a Pittsburgh oddball employment-wise but I can't imagine my situation is too unusual in the area.

Too many people choose the cheapest option in many scenarios without fully considering the situation as a whole.

I create detailed and complicated spreadsheets every December to compare all options offered by the employer. If I'm not happy, I add private options. It's amazing how it all pans out. Some years the more expensive option is the cheapest. Other years it's the mid priced option. Sometimes it's the private plan.

We constantly switch around, but we've had other options via employers for the past 20 years. I know there are some employers who only provide one option, but I'm fairly certain that isn't the norm since hubby has switched had 4 or 5 different employers in the past 20 years and I'm a job hopper who can't even count how many employers I had. There has never been only one option for us. I wouldn't say your situation isn't unusual, but it's not the norm.