Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Take Action before Consent Decree Expires

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Take Action before Consent Decree Expires

Article excerpt

2019 may be a happy new year for UPMC - but it will be a bad year for hundreds of thousands of Pittsburgh area residents for whom access to most UPMC hospital and doctor services will become unaffordable and, therefore, effectively denied. UPMC's consent decree with the commonwealth expires on June 30, 2019. UPMC will thereafter deem most subscribers to Highmark Advantage or commercial plans to be out-of-network.

Worse, according to UPMC's own website, UPMC will demand payment in advance from such persons. Worse yet, although not explicitly stated on UPMC's website, such charges will likely far exceed the typical reimbursements UPMC would receive for the same services from in-network insurers, or where applicable, from the federal Centers for Medicare and Medicaid Services (CMS).

Except for a few UPMC facilities, Highmark subscribers are assured treatment only for legally mandated emergency care (most likely, thereafter billed at exorbitant uninsured rates). And expect no follow-up care without payment in advance.

Please complain to everyone in power. Past and future donors should demand change. Allegheny County, the City of Pittsburgh and the Internal Revenue Service should review UPMC's tax-exempt status. Highmark should review antitrust laws or other potential legal actions.

Major plan sponsors should demand more from UPMC - and perhaps from Highmark, too. CMS should determine whether UPMC is violating the requirement that CMS payments under Medigap plans be "actuarially equivalent" to payments under Advantage plans. UPMC should serve the whole community.

Richard Finberg

South Park

Cut down on traffic

I recently read that Pennsylvania has joined with eight other states and the District of Columbia to participate in the Transportation and Climate Initiative, which aims to reduce carbon pollution by cutting down on traffic congestion and promoting pedestrian and bicycle use as well as mass transit (Dec. 19, "Pa. Signs on to Plan to Cut Car and Truck Emissions"). If Pennsylvania wants to cut down on traffic congestion in Pittsburgh, there is something that could be done that would have an immediate impact on achieving that goal. …

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