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S P E C I A L R E P O R T : H E A LT H I N S U R A N C E
FINAL SPLIT IS HERE Erie family navigates ne w health insurance la nds ca pe a nd fi nd s it h a s t o ma ke hard c h oice s
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By David Bruce | david.bruce@timesnews.com
PMC Hamot doctors have treated Lisa Puckly and her family for the past two decades. Both of Puckly’s babies were delivered at Hamot, her son’s cancer surgery was performed there, and the entire family saw a Hamot family physician until Puckly switched to a Saint Vincent Family Practice doctor earlier this year. Puckly, who is in her 50s, said she didn’t have much of a choice.
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SPECIAL REPORT
Jerry and Lisa Puckly, owners of Summit Hardwoods in Summit Township, are among the many people in northwestern Pennsylvania who are re-examining their health insurance and doctors as the end of the consent decree between UPMC and Highmark draws near. The time to act is now. For the Pucklys, they are switching from UPMC Hamot to Saint Vincent physicians because they plan to continue carrying Highmark insurance. [JACK HANRAHAN/ERIE TIMES-NEWS]
HEALTH
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“We have Highmark health insurance and next year we won’t have (in-network) access to Hamot or its doctors,” Puckly said. “We’re all going to have to switch.” The Pucklys, who own and operate Summit Hardwoods on Route 97, are like many northwestern Pennsylvanian families who are switching physicians and hospitals this fall to prepare for the end of the UPMC-Highmark consent decree on June 30. Once the consent decree expires, people with most Highmark insurance plans will no longer have in-network access to Hamot and Hamot-employed physicians for nonemergency medical care. The only way these patients can see a Hamot physician will be to pay the office visit’s entire cost in advance and out of pocket, then send the bill to Highmark for remittance. It’s not clear exactly how much of the bill Highmark will cover. In turn, those who choose UPMC Health Plan will no longer have in-network access to Saint Vincent Hospital and its employed doctors except for emergency care. “Many of my clients are upset about the end of the consent decree,” said Jeffrey Evans,an employee benefits consultant with Northwest Insurance Services. “They don’t like being pushed around by insurance carriers and told how to live their lives.” UPMC-Highmark storm brewed for years Problems between the two Pittsburgh-based health-care giants began in 2011. UPMC officials said it started with Highmark announcing a $475 million takeover of the financially troubled West Penn Allegheny Health System, UPMC’s main competitor in Pittsburgh. Highmark officials said they were forced to buy the health system due to UPMC’s rapidly increasing medical costs and the concern that Pittsburgh would turn into a single health-system town. Provider contract talks between UPMC and Highmark stagnated because UPMC now viewed Highmark’s newly created Allegheny Health Network as a competitor. Then-Gov. Tom Corbett helped convince UPMC and Highmark to extend UPMC’s provider contract with Highmark until the end of 2014. Highmark added Saint Vincent Hospital to its network in 2013, bringing the Pittsburgh battle to northwestern Pennsylvania. In June 2014, state officials brokered a deal where the two health-care giants signed fiveyear consent decrees in which
Here are the players involved in the UPMC-Highmark battle: UPMC • UPMC Health Plan, www.upmchealthplan.com, 877-563-0292 • UPMC Hamot, http://findadoc. upmc.com, 800-533-UPMC
This is an architect’s rendering of the $50 million, 104,000 square-foot-structure currently under construction on Saint Vincent Hospital’s campus that will house the emergency department and operating rooms and will extend from the Hardner Building at 2315 Myrtle Street to the north side of the hospital. The lower level of the three level structure will house physical plant and operations services. It’s expected to be completed by April 2019. [CONTRIBUTED PHOTO]
Highmark subscribers continued to have in-network access to Hamot and “rural” hospitals including UPMC Horizon in Greenville and UPMC Northwest in Cranberry Township, Venango County. The consent decree ends June 30 and officials from both UPMC and Highmark have said there will not be another extension. Hamot and its physicians will be out of Highmark’s network, while Saint Vincent and its physicians will no longer be in UPMC Health Plan’s provider network. When that happens, most subscribers with Highmark or UPMC Health Plan insurance will have to find another hospital or physician, or pay a lot of money out of pocket to be treated. “June 30, 2019, is the last day,” Hamot President David Gibbons said. “We have been clear on this.” Saint Vincent President Chris Clark, D.O. said: “We are ready, willing and able to be ready for the end of the consent decree.” Keeping their insurance means switching doctors Lisa Puckly knew the split was serious when she received a letter from UPMC in early 2018. The point of the message was that if she wanted to keep all of her family’s doctors, she would have to switch health insurers. Puckly and her husband, Jerry, discussed the matter with Evans, their insurance broker. He ran the numbers and discovered the choice was simple, at least financially. “The Pucklys have what I call a ‘grandmothered plan,’ which means their plan is still medically underwritten,” Evans said. “Their premiums are based more on their own medical history instead of just their ages and location like most plans since the (Affordable
Care Act) was passed, so if they are healthy or younger it can be quite a savings.” Evans determined that if the Pucklys switched to UPMC Health Plan, it would cost them about $6,000 more a year in premiums and the plan would have slightly higher copayments than their Highmark plan. The UPMC Health Plan would not be medically underwritten. Other health insurers were even more expensive, Puckly said. “It behooved us to stay with the Highmark plan but that meant switching doctors,” Lisa Puckly said. Before she switched, Lisa Puckly met one last time with her family physician. It was difficult, she said. “I wanted to stay,” Lisa Puckly said. “I’d been going there for 20 years before our children were born. I almost cried. I tried to explain to them that if I had a choice, I would stay.” National insurers also cover UPMC UPMC officials frequently point out that people don’t have to get their insurance through UPMC Health Plan to be covered at UPMC hospitals and physician offices. Several national insurance carriers also have UPMC in their provider networks. “There are a lot of ways to get to UPMC,” said Paul Wood, UPMC spokesman. “If you’re not comfortable with UPMC Health Plan, you can choose Aetna, you can choose Cigna, you can choose UnitedHealthcare.” Evans said these national carriers are beginning to offer more competitively priced plans in northwestern Pennsylvania but the most affordable plans, especially for individuals and smaller businesses, usually belong to Highmark or UPMC Health Plan. “If a client has a ‘grandmothered
Highmark • Highmark Blue Cross Blue Shield, https://discoverhighmark.com, 855-430-0754 • Saint Vincent Hospital, https:// doctors.ahn.org, 814-CONNECT or 888-258-3428 Other health insurers • Aetna, www.aetna.com, 800-872-3862 • UnitedHealthcare, www.uhc.com, 888-545-5205 • Cigna, www.cigna.com, 800-997-1654 Other health systems in Erie County • LECOM Health, www.lecomhealth. com, 866-4400 Free insurance counseling for Medicare recipients • A.P.P.R.I.S.E, 459-4581, Ext. 494 Health insurance brokers
plan’ from Highmark, we’re finding it’s cheaper to stick with that plan,” Evans said. “If it’s not ‘grandmothered,’ the UPMC Health Plan is less expensive. In fact, the small businesses I work with who remain with Highmark almost all have ‘grandmothered’ plans.” It’s about the value Lisa Puckly was the first member of her family to switch doctors but her husband and two sons are expected to follow. Jerry Puckly said he realizes he will need to make the change sometime before June 30, and he doesn’t want to get shut out of a particular office if there is a lastminute rush. His wife encouraged him by saying how smoothly her move went to a Saint Vincent family doctor. But Jerry Puckly said it’s about more than the red tape involved with changing physicians. It’s about the value, he said. “If you are cutting the number of available doctors by half, you should cut my premiums by half,” Jerry Puckly said. “But they’re not. My premiums are actually going up.” David Bruce can be reached at 870-1736 or by email. Follow him on Twitter at www. twitter.com/ETNbruce.
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The Vicary Insurance Agency Guaranteed Personal Service Health Care Reform Storm
Are you in compliance with Health Care Reform Regulations? Are you aware of the upcoming expiration of the Consent Decree with Highmark and UPMC? " Let the Vicary Insurance Agency’s Guaranteed Personal Service, also known " our Let the VicarySystem, Insurance Agency’s Guaranteed Personal Service, known Care as our GPS System, as GPS help you navigate through thealso Health reform storm andhelp theyou termination of the contracts between Highmark and UPMC on June 30, navigate through the Health Care reform storm and the termination of the contracts 2019. between Highmark and UPMC on June 30, 2019. team is here to guide you in the right direction when choosing an insurance " Our " Our team is here to guide you in the right direction when choosing an insurance plan and benefits plan and benefits program that works best for you and your employees. program that works best for you and your employees. " Due to to the in the Patient Protection andCare Affordable (PPACA) " Due thechanges changes in the Patient Protection and Affordable Act (PPACA)Care and theAct ending of the and the ending of the Consent Decree, we at Vicary Insurance Agency have Consent Decree, we atorganizations Vicary Insurance Agency haveguide partnered key organizations to help guide partnered with key to help youwith while using our GPS you whileWe using ourwork GPS System. We will withthese you to utilize these resources by helping educate System. will with you to work utilize resources by helping to educate youand and making this transition smooth possible. making this transition as smoothas as possible. Weas work for you! We work for you! " The following isisaabrief list oflistrequirements and benefitsand youbenefits or your organization may need to following brief of requirements you or your organization " The maycomply needwith to to beorin current maycompliance want to offer towith assure that youHealth are on theCare correctReform: course to Health Care ! Reform. Premium Only Plans (POP) ! Family and Medical Leave ! Health Reimbursement Account !! ! !! ! ! ! ! !! ! !
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SPECIAL REPORT
What to know, what to do about your health choices How to deal with the end of the UPMC-Highmark consent decree
Northwestern Pennsylvanians purchase health insurance in a variety of ways. Many of us pay into health plans offered by our employer or former employer, while others purchase an insurance plan on their own through the Health Insurance Exchange, through an insurance broker, or directly from a health insurer. Those 65 and older, or who have certain disabilities, often select a Medicare Advantage plan to augment their government insurance. No matter how you buy your insurance, you will likely be affected by the end of the UPMC-Highmark consent decree on June 30. See if you recognize your own situation in one of the following scenarios.
If you get health insurance through Medicare
MEDICARE PLANS
EMPLOYER PLANS
and other Allegheny Health Network hospitals and their employed doctors after that time.
About 800,000 Pennsylvanians are expected to purchase a Medicare Advantage health insurance plan for 2019, according to the Centers for Medicare and Medicaid Services. These plans are offered by private health insurers and provide medical and drug coverage beyond what traditional Medicare covers. Anyone who qualifies for Medicare can purchase a Medicare Advantage plan. Those who already have a Medicare Advantage plan who don’t select a new plan will continue with their current plan, which will be in effect until December 2019. 1. How does the end of the consent decree affect you? Those who have Highmark Medicare Advan-
ask each of your doctors if they will remain in your insurance’s provider network. If they aren’t, ask them if they can help you transfer to an in-network physician. 3. What decision do you need to make? You need
to decide what plan you want for 2019. You can change your Medicare Advantage plan every year between now and Dec. 7. Go to www.medicare. gov, call the A.P.P.R.I.S.E Medicare counseling program at 459-4581, Ext. 494, contact an insurance broker, or call a health insurer directly to learn about other plans. 4. How soon do you have to make that decision? Dec.
tage plans will not have in-network access to many UPMC hospitals, including UPMC Hamot, and their employed doctors after June 30. Those with Medicare Advantage plans with UPMC Health Plan will not have in-network access to Saint Vincent
7 is the deadline for 2019 coverage. A complete list of Medicare Advantage plans can be found at www.medicare.gov. You can compare their costs, benefits and in-network physicians and hospitals, and then enroll in a plan.
If you get health insurance from an employer or former employer
other Allegheny Health Network hospitals and their employed doctors after that time.
A growing number of Erie County employers are offering their workers and retirees younger than 65 a choice in health insurance plans, but a vast majority of them offer just one plan.
2. What should you ask your doctor? You should ask each of your doctors if they will remain in your insurance’s provider network. If they aren’t, ask them if they can help you transfer to an in-network physician.
1. How does the end of the consent decree affect you?
3. What decision do you need to make? If you have doctors who aren’t in your insurance’s provider network, you need to switch to in-network doctors or be prepared to pay significant out-of-pocket costs.
If you get Highmark or UPMC insurance through an employer or former employer, you need to understand which doctors and institutions are going to be “in-network.” Highmark plans will not have innetwork access to many UPMC hospitals, including UPMC Hamot, and their employed doctors after June 30. Those UPMC Health Plan insurance will not have in-network access to Saint Vincent and
If you buy your own health insurance
SELFPURCHASED PLANS
2. What should you ask your doctor? You should
Whether you buy health insurance directly from the insurer, an insurance broker or through the Health Insurance Exchange, it is important to determine whether your doctors and hospitals are included in your insurer’s provider network. 1. How does the end of the consent decree affect you?
Those who have Highmark plans will not have innetwork access to many UPMC hospitals, including UPMC Hamot, and their employed doctors after June 30. Those with UPMC Health Plans will not have in-network access to Saint Vincent and other Allegheny Health Network hospitals and their employed doctors after that time.
4. How soon do you have to make that decision?
You can keep your doctors until June 30, when the consent decree expires, but it might be a good idea to switch before then to ensure access to an
2. What should you ask your doctor? You can ask each of your doctors which health insurances they accept. 3. What decision do you need to make? You need to decide what plan you want for 2019. Open enrollment through the federal Health Insurance Exchange runs through Dec. 15. You can compare and choose plans at www.healthcare.gov. You can also buy health insurance from an insurance broker or directly from a health insurer. 4. How soon do you have to make that decision?
Enrollment ends Dec. 15 for coverage starting Jan. 1. If you buy your plan directly from an insurer, visit their websites or call them to find out if your physicians are in-network. Remember that each
A health insurance Q&A Here are answers to some common questions people have about the end of the consent decree By David Bruce david.bruce@timesnews.com
Some, but not all, plans have a $0 monthly premium and $0 office copayments. You can also look at Medigap plans. These plans do not restrict access to physicians or hospitals that accept Medicare and often have lower out-ofpocket costs. However, they also do not usually include drug coverage and can have higher premiums than Medicare Advantage plans. Erie County residents can schedule an appointment with A.P.P.R.I.S.E. You should take your current health insurance ID card, a list of physicians and a list of medications when you visit the counselor. If you want a plan that doesn’t include all of your physicians, you should begin searching for new ones. To find a UPMC doctor, visit http://findadoc.upmc.com. To find a Saint Vincent doctor, visit https://doctors.ahn.org. LECOM Health doctors accept both insurances and can be found athttps://lecomhealth.com/physicians. You can also call each hospital to find a doctor. Call UPMC Hamot at 800-533-UPMC, Saint Vincent at 814-CONNECT or 888-258-3428 and LECOM Health at 866-4400.
in-network doctor you prefer. Most insurers also offer a list of in-network providers on their website. Highmark’s provider list can be found at www.highmarkblueshield. com, while UPMC Health Plan’s list can be found at www.upmchealthplan.com/find. If any of your current physicians will be out of network after June 30, begin searching for new physicians. To find a UPMC doctor, visit http:// findadoc.upmc.com. To find a Saint Vincent doctor, visit https://doctors.ahn.org. LECOM Health doctors accept both insurances and can be found athttps://lecomhealth.com/physicians. You can also call each hospital to find a doctor. Call UPMC Hamot at 800-533-UPMC, Saint Vincent at 814-CONNECT or 888-258-3428 and LECOM Health at 866-4400.
insurer is trying to sell you their plans, not provide you with an objective overall comparison. An insurance broker will do that work for you and give you their opinion on the best insurance for you and your family. If you want a particular insurance but find some of your family’s physicians are out of network, you should start looking for new physicians. To find a UPMC doctor, visit http://findadoc.upmc.com. To find a Saint Vincent doctor, visit https://doctors. ahn.org. LECOM Health doctors accept both insurances and can be found athttps://lecomhealth. com/physicians. You can also call each hospital to find a doctor. Call UPMC Hamot at 800-533-UPMC, Saint Vincent at 814-CONNECT or 888-258-3428 and LECOM Health at 866-4400.
Highmark and UPMC officials have spent months explaining the ramifications of the end of their consent decree on June 30. In a nutshell: — People with Highmark commercial and Medicare Advantage plans will no longer have in-network access to most UPMC hospitals, including UPMC Hamot, once the consent decree expires. — Those with UPMC Health Plan insurance will no longer have in-network access to Saint Vincent Hospital and the others in Highmark's Allegheny Health Network. But questions remain. They include: Q Do people with Blue Cross Blue Shield health plans other than Highmark have in-network access to UPMC Hamot and its physicians? A They do only if UPMC has
negotiated a provider's contract with that specific Blue Cross Blue Shield plan. For example, UPMC has reached an agreement with Buffalo-based Blue Cross Blue Shield of Western New York but it must still be approved by the New York State Department of Health. Otherwise, many UPMC hospitals are considered out of network and patients must pay in advance and out of pocket for nonemergency care. Q By "many UPMC hospitals," which ones will still be in-network for Highmark subscribers after June 30? A More than a dozen UPMC
hospitals and their employed doctors will remain in-network for at least a few years after the consent decree expires. They include: • UPMC Children's Hospital of Pittsburgh; • UPMC Western Psychiatric Hospital; • UPMC Altoona; • UPMC Bedford; • UPMC Chautauqua; • UPMC Horizon in Greenville; • UPMC Jameson; • UPMC Kane; • UPMC Northwest in Cranberry Township. The Regional Cancer Center, which is jointly owned by Hamot and Saint Vincent Hospital and managed by UPMC, also remains in-network. However, it is expected to be
dissolved in late 2019 as the two Erie hospitals open their own cancer centers. Q Will Saint Vincent or any other Allegheny Health Network hospitals be in-network for those with UPMC Health Plan insurance? A No. They all will be out of
network.
Q What happens if I have Highmark insurance and I'm involved in an accident and taken to Hamot? A You will be covered at
Hamot and any other UPMC hospital at an in-network rate for any emergency care. Once you are examined and your condition is stabilized, you will likely be transported to an innetwork hospital such as Saint Vincent or Allegheny General.
Q Do any Highmark plans include UPMC in-network after June 30? A Only Highmark Medigap
plans for people who have Medicare insurance. Hospitals that accept Medicare are required by law to accept all Medigap plans, though they are not required to accept all Medicare Advantage plans— a more popular alternative to Medigap plans. If you have a Medicare Advantage plan from Highmark, you will not have in-network access to Hamot and its physicians. If you have one from UPMC Health Plan, you will not have access to Saint Vincent and its physicians. Q Do I have to switch my hospital and physicians now? A No, Highmark insurance
will still be accepted at Hamot and its physician offices until June 30. But you might want to switch at least a few weeks ahead of time to ensure a smooth transition.
Q Are primary-care doctors accepting patients? A Most, but not all, primary-
care physicians in Erie County are employed by Hamot, Saint Vincent or LECOM Health. All three health systems have said they are accepting new patients, though some individual offices are not. If you want to switch to an independent physician, you should call their office to see if they are accepting new patients. Information for this article was gathered from interviews with UPMC and Highmark officials, upmc.com, lecomhealth. com and https://faqs.discoverhighmark.com.
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HOW WE ARRIVED AT THIS POINT The decisions leading to 2019’s health insurance choice in western Pennsylvania May 2012 —
A consent decree between UPMC and Highmark will end June 30, eight years after troubles started
February 2011 —
Hamot Medical Center officially joins the UPMC health system and is renamed UPMC Hamot.
between the two Pitts-
UPMC, in a deal brokered by then-Gov. Tom Corbett, agrees to extend in-network coverage at all of its hospitals through December 2014 to Highmark subscribers with commercial and Medicare Advantage coverage. The contract had been set to expire June 30.
July 2013 —
Tom Corbett
UPMC announces it will no longer accept Highmark insurance at most of its hospitals and medical offices after 2014.
UPMC Hamot is expanding its Erie campus in preparation of the end of a consent decree between UPMC and Highmark on June 30. [CHRISTOPHER
July 2018 —
The Pennsylvania Supreme Court reverses a lower court’s ruling to extend access to UPMC hospitals for people with Highmark’s Medicare Advantage insurance plans. Access will end June 30.
MILLETTE/ERIE TIMES-NEWS]
burgh-based health-care giants. Here is a look at a timeline of the most significant events, as seen through the eyes of Eriearea residents.
March 2011 —
October 2012 —
Provider contract talks stall between UPMC and Highmark after Highmark announces it will acquire the West Penn Allegheny Health System, UPMC’s main rival in Pittsburgh.
June 2014 —
Saint Vincent Health Center agrees to join Highmark’s new health system, which is named the Allegheny Health Network. The Erie hospital is renamed Saint Vincent Hospital.
Saint Vincent Hospital officials expect to see more patients in 2019 after a consent decree between its parent company, Highmark, and UPMC expires. [CHRISTOPHER MILLETTE/ERIE TIMES-NEWS]
The headquarters for Highmark Inc. and UPMC at the US Steel Tower are close together in Pittsburgh but the two institutions are bitter rivals. A consent decree between the two health-care giants expires June 30. [KEITH SRAKOCIC/ASSOCIATED PRESS]
UPMC and Highmark, with a push from state officials, agree to extend their consent decree. UPMC will keep Hamot and its other “rural” hospitals in Highmark’s provider network as part of the agreement, which expires June 30, 2019.
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UPMC Hamot, Saint Vincent prepare for split with massive expansions Each Erie hospital is spending more than $100 million on construction projects By David Bruce david.bruce@timesnews.com
UPMC Hamot and Saint Vincent Hospital are preparing for the end of the consent decree by undertaking some of the largest expansion projects in each hospital's history. Hamot is building a $111 million, seven-story patient-care tower on East Second Street where the Hamot Professional Building used to stand. The new building will house 64 intensive-care unit beds and an expansion of the hospital's imaging department. Saint Vincent is expanding its hospital with a $115 million project that includes a new emergency department and operating rooms. The addition will connect the main hospital to the Hardner Building immediately to its north. "Quite frankly, I expect more patients will choose to see us and we are working to improve that patient experience," said Saint Vincent President Christopher Clark, D.O. Hamot President David Gibbons said he expects his hospital will continue to see a high number of patients after the consent decree expires June 30. Hamot has had daily patient census figures of more than 400 people in recent weeks, well above its average. Gibbons said he doesn't believe those numbers will decline much
when Highmark subscribers no longer have in-network access to Hamot. About 15 percent of Hamot's patients currently have Highmark insurance. "Any drop we might see from Highmark patients we expect will be picked up with increases in patients with UPMC Health Plan and Aetna," Gibbons said. "We have really seen an increase in people choosing UPMC Health Plan." In addition to these multimillion dollar expansions, both hospitals are building their own cancer centers after agreeing earlier this year to dissolve the Regional Cancer Center in late
2019. Hamot and Saint Vincent jointly created the RCC in 1987. Saint Vincent is spending $25.6 million to build the AHN Cancer Institute at Saint Vincent at the intersection of West 25th and Myrtle streets, about 150 yards from the hospital. Hamot's cancer center will be located in the RCC building at 2500 W. 12th Street. The hospital will spend between $6 million and $7 million on renovations and updates. David Bruce can be reached at 870-1736 or by email. Follow him on Twitter at www. twitter.com/ETNbruce.
This is an architect’s rendering of a $111 million, seven-floor patient tower to be built on the UMPC Hamot campus in downtown Erie. A groundbreaking ceremony was held on Oct. 5. It’s expected to open by mid2020. [CONTRIBUTED PHOTO]
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