UPMC-Highmark dispute a headache even for patients willing to pay out-of-network

A Pennsylvania woman who was treated at a UPMC hospital for broken bones related to a horse-riding accident told the Pittsburgh Post-Gazette she had to be her own care navigator due to a dispute between UPMC and Highmark.

Difficulties for Rebecca Himes began when she tried to schedule a follow-up appointment, which was supposed to be eight weeks out. However, Ms. Himes said a scheduling clerk told her that because she had Highmark insurance, an appointment couldn't be scheduled past June 30. That's when consent decrees between the two Pittsburgh-based rivals expire.

When Ms. Himes offered to pay out of pocket, the clerk inaccurately said doing so would be insurance fraud, according to the Pittsburgh Post-Gazette. A UPMC spokesperson told the publication the insurance fraud claim was "preposterous." Ms. Himes said the comment probably came from someone who is unfamiliar with insurance policy. But the incident still led to five follow-up phone calls, according to Ms. Himes.

After mixed messages and the numerous phone calls, Ms. Himes was told she could make a $200 down payment when she sees a UPMC physician after Highmark is no longer considered in network. She also said UPMC offered her a 40 percent discount if she paid her bill in full prior to the treatment.

"It's just people not being on the same page," Ms. Himes told the Pittsburgh Post-Gazette. "I was able to be my own care navigator, but I was really struggling."

Read more here.

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