Fábregas: Seniors, beware of Highmark's $0 health insurance pitch

The nerve.

What's unnerving about the latest Highmark-UPMC smackdown is that it involves seniors.

Yes, senior citizens who use Medicare - the same people who until now were untouched by this tiresome, torturous three-year headache.

People who use Medicare, the health insurance plan for Americans 65 and older, were not affected because the skirmish involved Highmark's commercial contract with UPMC. It ends in December, which means most Highmark customers won't have access to most UPMC hospitals and doctors without paying more.

Out of the blue, Highmark a few weeks ago began advertising a Medicare Advantage plan that excludes UPMC. The Community Blue Medicare HMO comes with the best sweetener a senior on a fixed income can dream of: a $0 monthly premium.

That's right, the plan is free, even though you get no in-network access to UPMC. Sounds like something worth considering, at least for those willing to forgo care in UPMC's vast network of hospitals.

Problem is Highmark isn't playing by the rules. In June, Gov. Tom Corbett and Attorney General Kathleen Kane announced a deal in which Highmark and UPMC agreed that senior citizens were basically untouchable. They belong to the 'most vulnerable' population and should always have access to UPMC, they said. Period.

What's surprising about Highmark's antics is how slick it has been as it lures unsuspecting seniors. In letters sent to members to promote the Community Blue Medicare HMO, Highmark Senior Vice President Barbara Gray made no mention that the $0-per-month premium excludes UPMC.

That's not right. It's hard enough to understand the ABCs of health insurance coverage, let alone try to decipher obscure letters that could cause seniors to make the wrong decision. If this cheap plan comes with certain restrictions, then say so.

As a business decision, it's understandable why Highmark would want to market a $0 premium plan with a limited network of doctors and hospitals. They need the business. Many employers are choosing health plans that offer in-network access to UPMC, the dominant health care provider in the region.

Interestingly, UPMC Health Plan and Aetna offer plans that instead of excluding UPMC, exclude hospitals in the Allegheny Health Network. Highmark officials have said that if those insurers can do it, why can't Highmark?

'The burden is on the state to explain to seniors why this company can't sell a zero-premium product and others can,' a Highmark spokesman said.

Good point. But the issue here is UPMC. Access to its hospitals is extremely important to seniors. Many value the peace of mind of knowing they can go to the Hillman Cancer Center and Western Psychiatric Institute and Clinic.

Both health care giants agreed seniors would have access to these facilities. Highmark's change of heart is suspect at best.

As with prior UPMC-Highmark disagreements, a lawsuit materialized. Imagine that - UPMC and Highmark embroiled in a lawsuit. The state is seeking an injunction against Highmark, saying the insurer is misleading seniors.

Though it's commendable that the state took notice of this kerfuffle, it is infuriating that it had to intervene. Highmark should know better.

Luis Fábregas is Trib Total Media's medical editor. Reach him at 412-320-7998 or lfabregas@tribweb.com.

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