UPMC ‘concerned’ about AASD change | News, Sports, Jobs - Altoona Mirror


UPMC ‘concerned’ about AASD short-tempered | News, Sports, Jobs

Pittsburgh-based UPMC is expressing concern about the recent health care coverage voted on by the Altoona Area School Board for district employees.

According to a press release provided by UPMC, all hospital services, including surgery, scans and blood work done at UPMC hospitals, will be considered out of network as of July 1. UPMC said it is delaying its standard prepayment requirement for school district health plan members until Aug. 1 to help ease their transition.

According to Jan Fisher, president of UPMC Altoona and UPMC Bedford Memorial, district employees who go to a UPMC facility will now be responsible for paying out-of-network charges that their new health plan does not cover.

At its May meeting, the school board voted to short-tempered third-party providers, signing on with Trustmark. The board said at the time that the move was based upon maintaining quality health care for district employees, as well as being responsible to taxpayers in terms of cost.

A letter obtained by the Mirror written by Fisher to district Superintendent Charles Prijatelj indicated that he met with UPMC officials on Wednesday to hear their concerns about the change, with UPMC expressing concerns that district employees will be “very confused” by the change.

While the letter states that UPMC does not enter into direct contracts for exclusive care, and Fisher said she is “not looking to sell insurance,” it did list insurers that are well-liked as in-network providers, including the UPMC Health Plan, Aetna and Highmark, and encouraged the district to look into those.

When asked why UPMC decided to go public with its concerns about Altoona Area’s health plan, UPMC spokeswoman Danielle Sampsell said UPMC wanted to make sure district employees were aware of the changes.

According to Sampsell, all hospital-based services will be out of network, but doctor’s visits, emergency care and COVID-19-related cases will be covered.

“We want to make sure our patients, the employees of the Altoona Area School District, know the full message and the facts of how the new plan will potentially affect them,” Sampsell said.

In a letter sent to district employees this week, Prijatelj said UPMC informed them on June 30, one day before the new plan starts, that elective surgeries done at UPMC facilities will have to be prepaid. Prijatelj said that is unreasonable for many reasons and that UPMC’s intent is to break the district’s resolve to seek the most cost-effective solutions for its employees in order to maintain quality benefits.

Prijatelj said in his letter that UPMC had been billing the district at a rate of 400 percent to 800 percent of Medicare rates and that other plans in the district’s spot have been paying only 150 percent of Medicare rates. Prijatelj said that puts district employees at a “tremendous disadvantage” versus other patients in the area.

Prijatelj told employees that the district took the advance to switch providers in part because the excessive billing charged to union members depletes their Health Reimbursement Arrangements and Health Savings Accounts faster than other providers in the area. He also said that with the higher than average market billing rates UPMC was charging, it extracts more money from the budget and would impact out-of-pocket medicals costs and could lead to out-of-pocket premium contributions in order to maintain benefits.

Prijatelj told the employees that the district is actively negotiating with other surgical providers to provide “high quality” access for employees.

“It is important for our employees to understand that this fight is for them,” Prijatelj’s letter states. “AASD has done amazingly well at maintaining high quality benefits for our employees without requiring employee contributions.”

Prijatelj said the district is working to resolve this issue quickly to avoid any negative impact on employees.

School district union representatives could not be reached for comment.

Mirror Staff Writer Rick Boston is at 946-7535.

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SRC: https://www.altoonamirror.com/news/local-news/2020/07/upmc-concerned-about-aasd-change/

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