She is from Halifax.
She owns and runs a small business.
She has been a longtime Highmark customer and a longtime Pinnaclehealth patient.
She, and presumably many like her in the Midstate, has a difficult decision to make regarding health coverage.
She didn’t want to be identified. We’ll call her Denise.
Denise recently got a letter from Highmark saying UPMC-Pinnacle doctors and hospitals will no longer be considered in-network for 2018.
It is not uncommon, says Pennsylvania acting Insurance Commissioner Jessica Altman, for the roughly five percent of Pennsylvanians not covered by insurance through work and purchasing on the market.
“Particularly in the individual market where there’s a drive to lower the monthly premium, a lot of plans have what we call narrow networks where they control costs by limiting the number of providers in the network,” Altman said.
Altman said Highmark and UPMC Pinnacle have agreed to work together for seven years, but that’s for people in larger group plans, not one-off customers like Denise.
So Denise, and people like her, have two choices: stick with Highmark and change doctors and hospitals to Penn State Hershey Medical Center or Geisinger Holy Spirit which are in-network, or stick with UPMC Pinnacle Health doctors and hospitals and switch to a likely more expensive insurance plan.
“Most health plans these days don’t have all the doctors in your area in-network, and that’s something you should think about when you are comparing health plans,” Altman said.
ABC27 reached out to both UPMC Pinnacle and Highmark. Both confirmed Denise’s story. Neither would go on camera, but both sent statements.
Highmark said it’s sad but understands that some customers will have to go elsewhere. It added, “Pinnacle was asked to be in the network but WOULD NOT (emphasis theirs) negotiate the appropriate discount that would make the product affordable.”
The statement from UPMC Pinnacle acknowledges that “patients experiencing confusion and frustration.”
But frustration barely describes what Denise is feeling. She spends $900 a month on premiums now with large deductibles and co-pays and fears those costs are only going up, especially if she tries to stay in the UPMC Pinnacle system. She sees employees in the Highmark group plans enjoying services under the UPMC Pinnacle umbrella and suspects she’s paying more and getting less because her company is too small to be in a group.
Denise feels penalized and victimized.
“Why are we being treated this way? Just because we are a small business and work extra hard? We do not have 9-5, we work 24-7,” she said. “Something is not right with this system.”
If you’re shopping for health insurance, the open enrollment is shorter this year. It must be completed by Dec. 15, not the end of January like previous years.