UPMC/Highmark dispute (Pittsburgh, Christiana, Oakland: 2013, university, prices)

[ferraris]

Originally Posted by Moby Hick

They should require them both (UPMC-UPMC insurance and Highmark-West Penn) to separate. I don't think it would be very hard for the state legislature to do so, especially since they need non-profit status and that gives the state a hammer that it wouldn't have otherwise.

Anything else is going to be bad for the region, but only UPMC is going to be worse in the long run.

Without Highmark's money we probably wouldn't have a WPAHS, at least not as we know it today.

[Moby Hick]

Originally Posted by Bong477

So if you have highmark insurance and want to keep UPMC docs, start looking for other insurance options including lobbying your employer to reconsider their insurance options.

Dear Boss,

In five years time, I'd like you to be in a situation where you have to pay whatever UPMC asks because you have no choice at all.

Sincerely,

Guy in Sector 7G

[Moby Hick]

Originally Posted by ferraris

Without Highmark's money we probably wouldn't have a WPAHS, at least not as we know it today.

If WPAHS hadn't been competing with UPMC in a non-profit version of survive, they wouldn't have the same set of financial problems. By the point Highmark came in, I agree there wasn't much choice.

[Hopes]

Originally Posted by h_curtis

Had an interesting experience calling my doctor's office the other day. They asked what insurance I have. I said blue cross/blue shield. They asked it if was Community Blue. I fortunately said, no. Then they said, if you had Community Blue, they couldn't even take me as a cash paying customer. SAY WHAT?

I believe Community Blue is medical assistance. Medical Assistance now has various health insurance company options and Highmark provides one. There are like four different health insurance companies that have medical assistance policies. It doesn't pay well. And they can't take cash if you're on medical assistance. This isn't limited to just UPMC doctors. Many AGH doctors won't accept Community Blue either.

[Moby Hick]

Originally Posted by villageidiot1

their board chairman states, "Losing 41,000 admissions to the Allegheny Health Network "would be the equivalent of, for example, the closing of UPMC Shadyside and UPMC Mercy and, with it, laying off 11,000 professionals."

Is UPMC exaggerating there or they really so inefficient that every hospital admission requires more than 1/4 of a professional's time for the year?

[jmn3]

Originally Posted by Hopes

I believe Community Blue is medical assistance. Medical Assistance now has various health insurance company options and Highmark provides one. There are like four different health insurance companies that have medical assistance policies. It doesn't pay well. And they can't take cash if you're on medical assistance. This isn't limited to just UPMC doctors. Many AGH doctors won't accept Community Blue either.

Community Blue is a select (limited) network plan - it is NOT a Medicaid plan at all.

UPMC refusing to take a CB member on a cash basis is basically ridiculous and makes no sense.

[Aqua Teen Carl]

I ended up in the emergency room at AGH about a month and a half ago. The doctor told me flat out, "if you have to be admitted to the hospital we won't be able to do it here. We will have to send you to a UPMC hospital because you have UPMC insurance". So yeah, if I wanted to be admitted they would had to kick me out of the hospital because of my insurance. This is one of many ridiculous stories I have had with healthcare in this country and I'm not even 30. I can't imagine what stories I'll have by the time I'm 60.

Healthcare is the United States is such a complete joke.

[villageidiot1]

We have two problems with healthcare in Western PA. The first is Highmark Blue Cross has had a monopoly on health insurance for as long as most people can remember. The other is that UPMC has been allowed to acquire most of the hospitals in Western PA and will keep acquiring more as hospitals run into financial problems. Their monopoly now extends north to Erie and east to Altoona and Bedford. I don't think it will be long until they start making a move into Ohio and West Virginia with Wheeling and Weirton as likely targets

UPMC has a strangle hold on Highmark. UPMC's strategy is to encourage other payers to move into Western PA to break Highmark's dominance. These payers will be able to offer access to both the UPMC and Allegheny Health Network providers. UPMC doesn't mind providing competition to its UPMC Healthplan if they can break Highmark's monopoly. They are satisfied with UPMC Healthplan being mainly an insurance product for UPMC/Pitt employees. Highmark's only defense is to financially back its own providers, the Allegheny Health Network, but it will be a losing proposition in the long run.

[Aqua Teen Carl]

I hope that one day I'll look back at stuff like this and say "Do you remember when healthcare was for-profit? You youngins don't understand all the garbage we went through. Get off my lawn etc. etc."

[Moby Hick]

Originally Posted by Aqua Teen Carl

I hope that one day I'll look back at stuff like this and say "Do you remember when healthcare was for-profit? You youngins don't understand all the garbage we went through. Get off my lawn etc. etc."

Highmark and UPMC are both non-profit, technically.