Can someone make sense of this? (price, to move, car)

[trackstar13]

Hopes

I appreciate your researching the issue further and this is just one of those things that impacts me and others around me so much that I have been researching it extensively. You are 100% right when you say health insurance is moving to more of a high deductible model and this is what scares me the most because I have been told that I have excellent healthcare at an amazing price by many people so I can only imagine what others are going through in regards to this debacle. Especially if someone is going to UPMC for cancer treatments or in Erie UPMC Hamot is very highly ranked for various heart surgeries and treatments. If someone has Highmark insurance in one of the aforementioned situations that will really influence them. I can only imagine how this is going to impact residents of western PA and I am hoping the governor intervenes or UPMC/Highmark negotiate something at the final hour. By the time this deal expires I am sure my deductible and out of pocket costs will be higher than they currently are so that will make it even worse.

[Hopes]

My plan through Highmark is awful. Keep in mind, it's an insurance policy for people with pre-existing conditions.

It is being cancelled so I will be switching to my husband's group plan this month.

$1,000 Network Deductible
$5,000 Network Out of Pocket
$10,000 Out of Network Deductible
$20,000 Out of Network Deductible
80%/50%

Now I'll look at the Highmark plan mentioned earlier in this thread.

[greg42]

Originally Posted by track2514

Okay I can agree with what you are saying at the end of this post. To me paying an extra $2,000 to $5,000 out of pocket for out of network providers is costly and I believe it is for many people in western PA. I should have said in my original post that many people have a deductible or a specific amount that they have to reach before their healthcare will pay a significant portion for out of network providers. For me I try to stay in network because that $2,000 is a significant amount of money to me. I agree that some people may be willing to pay for the difference to see provider's that are deemed out of network, but I think we can both agree that if UPMC is out of network a significant amount of Highmark subscribers will have to investigate the cost of seeing a UPMC doctor.

I would tend to agree with this. Without making too big of a generalization I would hypothesize that a significant chunk of people do not have an additional few grand to make sure they are going to what they think are the "best" doctors. That is a significant privilege. I wouldn't do that, wouldn't generally feel like I could afford to do that. If we were coming to second or third opinions on something life threatening or terminal or extremely tricky, then maybe we'd talk about that. But even a lot of major things are routine enough that it is not worth it to go out of network and pay a lot of extra money to have some perceived "best", even if one actually has the means to do so.

[trackstar13]

Hopes I just tried to rep you for the research and informed discussion, but it said I must spread the rep points around sorry.

[Hopes]

For my Highmark plan, I agree that's a significant hit for out of network. If I had cancer, I'd go out of network for the best treatment though regardless of the cost. We had a cancer scare (that turned out to be nothing) and we planned to go to Baltimore's John Hopkins. For less important treatments, yes, this would have a huge financial impact I wouldn't want to pay for out of network. I'd only pay that if my life depended on it. If my life depends on it, I wouldn't seek treatment at any Pittsburgh hospital anyway.

[Hopes]

I agree that most people won't think like I do. For example, if my husband's employer provided us with terrible options, I would shop around for private policies. I would be willing to pay a higher monthly premium to have better coverage, lower deductible and out of pocket, etc. I view it as saving money in the long run. But I realize most people won't make spreadsheets comparing plans like I do. LOL It's like gambling. If we're not feeling healthy, we opt to pay higher premiums.

[trackstar13]

Originally Posted by Hopes

If my life depends on it, I wouldn't seek treatment at any Pittsburgh hospital anyway.

Yes this is true and one of my family members had a bout with cancer and after months of treatments at UPMC with no results they decided to try the Mayo Clinic and it literally saved their life since they have been in remission for over 5 years now.

[Hopes]

Originally Posted by track2514

Yes this is true and one of my family members had a bout with cancer and after months of treatments at UPMC with no results they decided to try the Mayo Clinic and it literally saved their life since they have been in remission for over 5 years now.

It's ironic that UPMC advertises to chose your healthcare "as if your life depended on it."

Mayo was my second choice. For the specific cancer I was facing, John Hopkins ranked the highest in the nation. I was thankful it wasn't on the other side of the country. Fortunately, I didn't have cancer but Hopkins was our plan last year.

We have a friend who goes to Baltimore for treatment for cancer of the pancreas. When he was diagnosed at UPMC, they pretty much told him to kiss his ass goodbye and get his affairs in order. They weren't even going to treat him, told him he had months to live. That was almost 4 years ago and he's doing really good. He still has cancer, but he's still alive and still fighting it.

[Hopes]

Originally Posted by track2514

I am hoping the governor intervenes or UPMC/Highmark negotiate something at the final hour.

We both want the same thing. I want the government to intervene. The current contract that UPMC refuses to sign will be one step towards providing healthy competition. I'm sure they'll reach an agreement. As someone mentioned earlier in this thread, they go through this posturing all the time.

[villageidiot1]

Also be aware that UPMC Health Plan has their Advantage Network and Health Plan Network. The Advantage Network is a home host network consisting of hospitals and facilities owned by or
affiliated with UPMC. The UPMC Health Plan Network consists of all Advantage Network providers along
with a broader range of hospitals and facilities. Going out of the Advantage Network results in an annual deductible of up to $1100 individual/$2200 family with the insurance that UPMC offers their employees.

I'm sure they'll reach an agreement. As someone mentioned earlier in this
thread, they go through this posturing all the time.

Unless the state sues on antitrust grounds, what is the incentive for UPMC to sign the contract? The problem is providers should not have been allowed to get in the health insurance business. Payers and providers have different business incentives. We now have a situation where WPAHS needs someone to save them from bankruptcy and Highmark is the only potential savior.

Just suppose Highmark and UPMC don't sign a contract. Doesn't this open the door for other health insurers such as Cigna, United, Aetna, Humana, Coventry, etc. to move in and sign contracts with both Highmark and UPMC? Would UPMC have an incentive not to negotiate with these payers? If an insurer such as United Healthcare could provide a better insurance plan than either UPMC or Highmark by using their providers, than it would seem the market forces are working. If not, wouldn't we all be better off if Medicare replaced all the private health insurance companies?

With true competition, we would have exclusive health networks competing on quality and price against inclusive networks with access to all providers. Health insurance would be sold directly to consumers the way car insurance is currently sold. In our current system, what value added do health insurers provide, especially when the major players are both payer and provider?