Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Highmark Subscribers Still Face a Minefield for Upmc Care Insurer Due to Submit Transition Plan Next Week to Clarify Continuity Provision

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Highmark Subscribers Still Face a Minefield for Upmc Care Insurer Due to Submit Transition Plan Next Week to Clarify Continuity Provision

Article excerpt

Anyone who is curious about what navigating the local health insurance-medical care scene will be like in coming months and years can stop by Lenzi's Restaurant in Monongahela, Washington County, and speak to owner John Timko.

Last week, an office worker for Mr. Timko's cardiologist - a UPMC physician he credits with saving his life after a heart attack nearly five years ago - informed him they were canceling his regular appointment, scheduled for Monday.

The reason: After watching his UPMC Health Plan premiums jump to what he considered an unaffordable $1,800 per month, Mr. Timko had switched to Highmark Community Blue insurance Jan. 1.

UPMC has refused to see Community Blue members since early 2013, even if they're willing to pay cash, because the low-cost plan pays lower rates and excludes many of the UPMC facilities and physicians from its in-network directory.

It looked as though Mr. Timko unknowingly was caught in the middle and would lose his physician.

After an inquiry by the Pittsburgh Post-Gazette this week, though, UPMC has granted an exception for Mr. Timko so he can keep seeing his doctor.

UPMC spokesman Paul Wood also said, under continuity of care provision in the June 27 consent decree brokered by Gov. Tom Corbett and Attorney General Kathleen Kane, Mr. Timko will continue to see his UPMC physician on an in-network basis after the UPMC- Highmark contract ends Jan. 1.

But that's not necessarily the case, Highmark spokesman Aaron Billger said Thursday, adding only that "we continue to work with state regulators to determine which provisions apply to Community Blue and which do not."

While Mr. Timko's situation appears to have a happy ending, at least for now, the ongoing Highmark-UPMC battle for many has generated a mix of confusing and sometimes conflicting information. Highmark is scheduled next week to submit a formal transition plan for when the two health care nonprofits separate Jan. …

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