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Editorial: UPMC’s prepay policy changes rules

October 12, 2018

UPMC’s slogan is “Life changing medicine.”

That has never seemed more true.

On Monday, UPMC made it known that there was a shake-up in the way things were being done if you were a senior covered by Highmark’s Medicare Advantage plan.

Come June 30, if you need a new knee and you have another health care plan, it’s business as usual. Schedule your surgery, show up, get that bionic joint and the hospital will bill your insurance company, just the same way they do hundreds of times every single day.

Unless you have Highmark. In that case, UPMC wants the money. Up front. All of it. No partial payments and no payment plans. You can’t put your knee on layaway.

The timing is everything in this announcement. It comes two weeks before open enrollment begins for the coming year, giving seniors who might expect to have a nonemergency procedure on the horizon the opportunity to think about where they want it done, how it would be paid, and how many hoops they want to jump through with that presumably tricky knee.

An advertisement mailed this week told people they can continue their UPMC access by choosing UPMC insurance or plans by other in-network carriers such as Aetna, Coventry, Cigna and United Healthcare.

The June 30 date comes as the agreement between the two health care companies is set to end, and gives the impression that UPMC is looking to return immediately to the ugly turf war that was playing out when the state got involved in 2014.

That isn’t the kind of thing you expect when you live in an area that has become known for its medical options. It’s nice to have world-class facilities in the backyard. It’s good to know that if you need help, one of the top 15 hospitals in the country is right there.

What is less reassuring is that the hospital ranked 12th best in the nation at treating the elderly is willing to resort to making those same older Pennsylvanians count up their quarters and dollar bills to pay in advance for a procedure that could be handled like any other medical treatment performed on a person with insurance.

According to the National Center for Health Statistics, part of the Centers for Disease Control and Prevention in Atlanta, about 8 percent of adults don’t take their prescriptions as directed to save money. Many skip the medication.

Now imagine it isn’t a $100 bottle of insulin or a $300 bottle of pills. It’s not the copay that you are trying to find in your bank account or your couch cushions. It’s thousands of dollars for that new knee, or gallbladder surgery, or other procedure that extends or improves life but isn’t an emergency.

This is not about indigent patients. This is not about people who do not have required coverage. This isn’t people using the emergency room as a primary care provider and sticking the hospital with the bill. This is people who carry an insurance card, see a regular doctor and are following the rules that came with that coverage.

Maybe it’s less “Life changing medicine” and more medicine changing the rules.

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