UPMC-Highmark consent decrees near expiration

The UPMC-Highmark division is scheduled to take place on or after July 1, unless an appeal or agreement is made.

Kathy Noce wants to keep her family doctor so much that she is willing to pay $ 100 to $ 200 per visit to see it.

Noce, 59, has been treated by Roman Bojewski, D.O., of UPMC Hamot for about 10 years. He played a vital role in helping Noce to be diagnosed with thyroid cancer in a treatable stage.

But Noce has health insurance Highmark and Bojewski will be out of the insurance network of physicians if the UPMC-Highmark consent decrees are allowed to expire as scheduled on June 30.

"I have not changed my doctor, I was expecting some agreement," Noce said. "If not, I'll pay for my visits from my own pocket. ... Dr. Bojewski cares about his patients and I trust him. "

Noce, like many other patients, is frustrated by the eight-year battle between Pittsburgh's two giants of health that seems to culminate in the scheduled end of the consent decrees. The decrees were designed to give everyone a window of five years before Highmark and UPMC basically takes separate paths.

But there is some uncertainty as the deadline approaches. Pennsylvania Attorney General Josh Shapiro's spokesman said this week that Shapiro will announce on Monday what he plans to do with regard to the consent decrees.

It is not known if Shapiro will announce that his office will appeal the decision of a Commonwealth Court judge that the consent decrees will expire on June 30 or if an agreement with UPMC is imminent.

Unless consent decrees are extended, Highmark members will no longer have access within the network to UPMC Hamot and most other UPMC hospitals and practices. Members of the UPMC health plan who have Saint Vincent Hospital in their network will no longer have it on July 1.

"We have insisted with our clients that if you need to change your hospital or doctor, do it now," said Jeffrey Evans, an employee benefits consultant at Northwest Insurance Services. "Don't wait".

The leaders of Hamot and St. Vincent said that their hospitals and primary care networks are accepting new patients, although certain individual doctors' offices are full. Saint Vincent's president, Christopher Clark, D.O., said that patients who switch from a primary care doctor from Hamot to a Saint Vincent can get an appointment the same day.

It is likely that patients have to wait longer to see a specialist, such as an endocrinologist or a neurologist.

St. Vincent is seeing a significant increase in his number of patients, both in the hospital and in the offices of his doctors, Clark said.

"Our visits to the emergency department increased by 5 percent (so far in 2019 compared to 2018), our observation/hospitalization visits increased by 10 percent and our visits by primary care physicians increased by 5 percent," said Clark.

Hamot has seen record numbers of patients hospitalized in his hospital in recent months, said Hamot president David Gibbons. Even though Highmark patients have been switching to other hospitals and doctors' offices, they have been replaced by those with other insurance such as UPMC Health Plan, Aetna or United Healthcare.

Gibbons also addressed the concerns that people have had about what happens if a patient with Highmark insurance is in the middle of attention in Hamot when the consent decree ends. He said that the chemotherapy patients at Hamot had the option to switch to St. Vincent at the start of their current round of treatment or transfer after June 30.

Emergency patients will continue to receive treatment at Hamot, the only trauma center in Erie County, regardless of insurance until their medical condition stabilizes, Gibbons said.

"We will work collaboratively behind the scenes with Highmark for any hospitalized patient we have with Highmark insurance," Gibbons said. "We're not going to do anything that endangers the patient's safety."

Jim Teed, regional vice president of sales at Highmark, said UPMC officials announced in May that emergency patients at Hamot with Highmark insurance would be covered within the network even after they are medically stable.

"We still have to do it in writing," said Teed. "Otherwise, Highmark must be notified within three hours of the patient's stabilization to a hospital (within the network). We have an ambulance dedicated for that purpose. "