10K | Erie Times-News | GoErie.com | Sunday, February 16, 2014
ERIE 2014
Clock ticks on tiff
Insurance sign-ups far easier
By DAVID BRUCE david.bruce@timesnews.com
Local patients and employers will likely face a difficult decision later this year: Highmark or Hamot? A continuing squabble between western Pennsylvania’s largest health insurer and the region’s largest health system could leave Highmark customers with no access to UPMC Hamot or its physicians, except for emergency cases, when their provider’s contract ends Dec. 31. “This is a surprise,” said Jeff Evans Jr. of Employee Benefits Services, 4740 Peach St. “We were being told (by Highmark representatives) — even up to the end of 2013 and into 2014 — that Hamot would be an exception to the whole dispute. There were a lot of employers who renewed with Highmark for Jan. 1 on the beliefthatHamotwouldbeanexception.” Highmark and the University of Pittsburgh Medical Center have been battling since 2011, when Highmark announced it was buying the West Penn Allegheny Health System. The insurer later purchased Saint Vincent Hospital and created the Allegheny Health Network, an integrated delivery system. UPMC officials said they wouldn’t pursue new provider’s contracts with Highmark because they viewed the Allegheny Health Network as a competitor. But in July, UPMC board members told Highmark they were interested in extending Hamot’s contract. About 20 percent of Hamot’s net patient income — or about $80 million a year — comes from treating Highmark members. At that point, the stories diverge. Hamot President James Fiorenzo said negotiations on a new provider’s contract continued until October. “We feel Highmark has reneged on a commitment to a contract with Hamot,” Fiorenzo said. Highmark spokesman Aaron Billger said there were no true negotiations, only a UPMC proposal that called for a nearly 50 percent increase in Hamot’s reimbursement from Highmark. “Our position hasn’t changed,” he said. “A systemwide contract with UPMC is in thebestinterestoftheentirecommunity.” UPMC officials are not interested in negotiating a systemwide contract because they believe, based on court filings, that Highmark’s plan for keeping open West Penn and Allegheny General hospitals is to siphon patient admissions
The website still freezes up once in a while, but Michelle Robertson and her staff are having a much easier time enrolling people in health plans offered on the Health Insurance Exchange. Glitches plagued the federal government’s www.healthcare.gov website when the exchange opened in October. It was nearly impossible for anyone to enroll, let alone see or select health plans. “The website, now, is working great for the most part,” said Robertson, Erie County’s only certified Health Insurance Exchange navigator. “There are still a few issues, but nothing like we saw.” More than 81,000 Pennsylvanians signed up for insurance through the exchange as of Dec. 28, the last time the government provided enrollment statistics. Erie County-specific data has not yet been released. But Robertson said she and her staff have seen almost 600 individuals and families, and many others have enrolled on their own or with help from insurance providers and agents. About 27,000 Erie County residents are uninsured. Some of those who enrolled, like Melanie Vadzemnieks, have already received their new insurance cards and seen a physician. “I signed up on my own on Dec. 23, the last day I could and still get coverage on Jan. 1,” said Vadzemnieks, whose insurance through COBRA expired at the end of 2013. “I received my insurance card and went to my primary-care physician (in mid-January).” Vadzemnieks’ experience was far different from those who tried to enroll in October or November. Robertson would spend hours trying to enroll one person on the website, sometimes having to type their information in multiple times. Only one of the first 70 people Robertson helped was able to enroll in a health plan through the exchange. “Now we’re able to enroll most people in less than an hour,” Robertson said. One of the most popular plans among Erie County enrollees is Highmark’s Community Blue, Robertson said. Community Blue is a narrow-network plan that doesn’t include most UPMC hospitals, including UPMC Hamot. — David Bruce
MAGGIE PORTZLINE/Erie Times-News
FILE PHOTO CHRISTOPHER MILLETTE/Erie Times-News
AT TOP: A Highmark Blue Cross Blue Shield Direct store is open in Millcreek Township. ABOVE: A full-service kiosk is set up at UPMC Hamot for UPMC Health Plan clients. from UPMC hospitals in Allegheny County, Fiorenzo said. Though the current contract runs for 10 more months, Evans said time is already running short for local businesses that renew their health insurance in July. Negotiations typically start in April for those businesses. “There isn’t a whole lot of time for these companies,” Evans said. “If there’s no agreement, then they would have to start looking at some of the other health insurers out there who would give them access to all hospitals.” Evans thinks Highmark and UPMC will eventually reach some sort of agreement. “Highmark and UPMC need each other to survive,” Evans said. “The loyalty customers have in this area for Highmark is strong, but it only goes so far. There is
E R I E
also extensive loyalty to Hamot.” The two health-care giants are also getting a firm prod to the negotiating table courtesy of state legislators. A bill is expected to be introduced in thestateSenate,andonehasalreadybeen introduced in the state House, that would require integrated health systems like UPMC and Allegheny Health Network to contract with any willing health insurer. “We all want to pick and choose the facilities we want to go for health care, and choose the doctors we want for health care,” said state Rep. Curt Sonney, R-4th Dist., of Harborcreek Township, a cosponsor of the House bills.
D A V I D B R U C E can be reached at 8701736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.
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