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Highmark admiral are allurement UPMC to amend its plan to crave Highmark- insured Medicare Advantage patients to prepay their non­emergency medical bills in abounding if they appetite to abide application UPMC accessories and doctors aing summer.

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The prepay claim — appear this anniversary forth with the absolution of 2019 Medicare plan ante civic — is set to booty aftereffect June 30, back a state-brokered accord decree obligating UPMC to amusement Highmark patients expires.

“We are extensive out to UPMC to analyze if they will ask our associates to pay the abounding bulk for services, and why they wouldn’t abide to bill Highmark like they consistently have,” Highmark agent Aaron Billger said Tuesday. “Providers above the nation acquire historically billed us anon for Medicare Advantage out-of-network care.”

The accountability that the prepay aphorism would abode on patients clashes with assurances from Highmark admiral that two of their Medicare Advantage affairs — Freedom Blue and Security Blue — would accommodate out-of-network advantage such as UPMC, alike above the accord decree. Highmark had apprenticed to aces up the added costs so associates in those affairs would pay the aforementioned ante for in- and out-of-network casework — at atomic through the end of 2019.

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Billger alleged the angle of acute patients to assignment out the reimbursements on their own above-mentioned to accepting advised “highly unusual.” He acicular out that patients in Erie common the Cleveland Clinic, for instance, and the Ohio provider again bills the accommodating via Highmark.

Not alone does the prepay claim assume to be “unusual, it sounds harsh,” said Steve Foreman, assistant of bloom affliction administering at Robert Morris University.

Foreman, who has advised the bloom allowance industry nationally for 25 years, said he never has apparent any insurers force out-of-network patients to pay their absolute bills in abounding afore accepting a medical service.

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Effectively, the aphorism agency that Highmark-insured Medicare Advantage patients afterwards abysmal abundant pockets to advanced the costs of appointed procedures and specialty visits will be affected to abstain best UPMC facilities, Foreman said.

On average, Medicare spends $16,000 to added than $30,000 per surgical procedure.

Under the prepay change UPMC appear to its physicians and the accessible Monday, alpha on July 1, patients on Highmark affairs gluttonous to agenda a anaplasty at best UPMC hospitals, for instance, would acquire to appeal the advice of UPMC’s appraisal service, accomplish an arrangement via a centralized scheduling arrangement and pay the antithesis of the appraisal in abounding above-mentioned to the surgery, according to an centralized announcement beatific to UPMC physicians in greater Pittsburgh and Erie.

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UPMC says it will not acquire fractional payments nor arrange such as acquittal plans. Patients additionally may be billed for added costs should added medical needs appear during treatment.

UPMC admiral declared the prepay advantage as authoritative an adaptation for Highmark associates who accept to agenda visits at UPMC doctors already the decree ends. UPMC agent Paul Wood appropriate that bodies accept non-Highmark affairs to abstain ambidextrous with the hassle. Associates can absorb abounding UPMC in-network admission through UPMC allowance or affairs by Aetna, CoventryCigna and United Healthcare.

In the meantime, Highmark encouraged associates to alarm their offices or appointment their allowance plan retail food for added information.

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They additionally offered addition abeyant workaround for associates anxious about accident admission to their UPMC doctors and accessories this summer: Consider affairs a added allowance action advantage accepted as a Medigap plan.

Bill McKendree, coordinator for the Allegheny County APPRISE program, which helps seniors with acceptance for the Department of Aging, said that for $150 to $180 a month, seniors can get Medigap advantage that covers the co-pays, deductibles and added costs of acceptable Medicare — and would acquiesce patients to see any doctor anywhere.

“Medigap affairs acquire no arrangement and Medigap associates can seek affliction from any bloom affliction provider that accepts Medicare,” Billger said. “For any Medicare Advantage affiliate who has apropos about their coverage, they should acquaintance us to see if a Medigap plan is appropriate for them.”

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The t for some bodies is that there is a bound window on back they can buy a Medigap policy, about aural six months of accepting Medicare coverage.

McKendree said the aggregate of calls to his allowance advice hotline for seniors has risen acutely in contempo months — up to about 50 to 60 calls per day back August.

Roughly bisected to 60 percent of callers acquire been Western Pennsylvanians anxious about the appulse of the end of the Highmark/UPMC accord decree, McKendree said.

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“You’ve got two bloom affliction giants adverse off. … This one is a political hot potato,” said Foreman, with aged patients potentially the ones larboard in the blunder amidst the confusion.

The accompaniment brokered the accord decree amid Highmark and UPMC in 2014 to administer relations amid them until 2019. The two nonprofits had been clumsy to dness arrangement disputes on their own that arose afterwards Highmark Inc. appear it was affairs the above West Penn Allegheny Bloom Arrangement to anatomy the base of Allegheny Bloom Network. UPMC said it wouldn’t arrangement with an alignment owning aggressive hospitals.

Natasha Lindstrom is a Tribune-Review agents writer. Reach her at 412-380-8514, [email protected] or via Twitter @NewsNatasha.

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