and therefore being charged much higher fees for everything. However, for those of us on Medicare, Medicare is our primary insurer and Highmark is our secondary - so apparently UPMC does not dare declare Medicare as being "out of network". Entirely too much testosterone in the corporate suites at both organizations - it's like the Hatfields and the McCoys. Why do they sue each other? Because they can.
Bits and pieces on the general topic:
I think it is too early to change insurers - particularly if you could get hit with pre-existing conditions denials down the road.
UPMC's president/CEO, Jeffrey Romoff's compensation package was more than $6 million in 2012! That's $4.3 million base salary, plus bonus and other compensation. This for a non-profit!
Saw a tweet: "State Rep. Christiana (R!?!) seeking sponsors for bill requiring UPMC to accept Highmark." The drama continues.
And check out the series in the New York Times comparing costs of healthcare between US and other developed countries.
The most recent segment, which was discussed on NPR yesterday, dealt with hip/joint replacement. An American whose insurance denied covering him for hip replacement, saying it was a pre-existing condition, found out he'd have to pay over $100,000 to have the procedure done in the states, but could go to Belgium - which he did - and got EVERYTHING: top-of-the-line artificial hip (made in the States), operation, top orthopedic surgeon,operating room/recovery room costs, all doctors' and nurses' fees; medicine, 5 day hospital stay, week at a rehab center, PLUS round trip airfare between the US and Belgium - ALL FOR $13,660.00.
Belgium has among the lowest surgical infection rates in the world, LOWER THAN IN THE U.S., and is known for good doctors. While most Belgian physicians and hospitals are in business for themselves, the government sets pricing and limits profits. Hospitals get a fixed daily rate and surgeons receive a fee for each surgery, which are negotiated each year between national medical groups and the state. "Mr. Shopenn’s surgery, which was uneventful, took place on a Tuesday. On Friday he was transferred for a week to the hospital’s rehabilitation unit, where he was taught exercises to perform once he got home. 12 days after his arrival, he paid the hospital’s standard price for hip replacements for foreign patients. 6 weeks later he saw an orthopedist in Seattle, where he was living at the time, to remove stitches and take a postoperative X-ray. “He said there was no need for further visits, that the hip looked great, to go out and enjoy myself,” Mr. Shopenn said.
http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?smid=fb-share&_r=0
U.S. manufacturers and "intermediaries" (?) would have charged him up to $37,000 for a device they manufacture for $350; and $65,000 for the hospital - PLUS surgeon's & anesthesiologist's fees; week in rehab. Then the typical US hospital ripoff: $9 for a Tylenol tablet;$70 for use of a heating pad.
The hip implant for Joe Catugno, a patient at the Hospital for Joint Diseases in New York, accounted for nearly $37,000 of his approximately $100,000 hospital bill.
Is everybody clear about the mark up? From $350 to $37,000 ! !
Read the great article to get the disgusting details of how Big Medicine cuts deals with European governments, which demand it, to keep costs down - but gets by with charging unconscionable fees in the US.
He described the Belgian hospital as modern, with new furnishings and equipment - but plain and basic. No Starbucks in the lobby, no elaborate landscaping outside, or artwork inside. I know the new UPMC hospital in Monroeville, PA, has flat screen TVs in each room, a kitchen with a brick oven for pizza, etc.
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