Friday, February 13, 2009

Woman fighting UPMC rejection of military health plan

Woman fighting UPMC rejection of military health plan

Thursday, February 12, 2009
By David Templeton, Pittsburgh Post-Gazette
Bill Wade/Post-GazetteJean Rohal, 40, of Bridgeville, is protesting that UPMC will not accept Tricare, a health insurance plan that covers active-duty military personnel.A Bridgeville woman is seeking congressional help in an effort to reverse a UPMC policy against accepting the health insurance plan for the region's 7,808 active-duty military personnel, their families and retirees.

Jean Rohal, 40, said it's shameful that University of Pittsburgh Medical Center hospitals and medical centers turn away active-duty service members from all branches, including the National Guard and reservists, especially in a time of war and economic distress.

She said she's been told UPMC doesn't accept Tricare, the military health plan, because of low reimbursement rates.

"I'm lucky that my husband is currently at home, but what about the people with spouses deployed?" Mrs. Rohal said. "They have spouses overseas, and now they have to deal with this."

She said that UPMC is the region's largest health-care provider, so its refusal to accept Tricare puts undue burden on military families.

Mrs. Rohal and her husband, an Army staff sergeant whose name she asked not be published, received a Jan. 15 letter from Tricare assigning the Rohals a new physician. The change was necessary because their current physician is affiliated with UPMC.

She also would have to find a gynecologist unaffiliated with UPMC. "I guess they don't think our soldiers and military families deserve the best in health care," she said.

Only three of UPMC's 15 hospitals -- Mercy, Horizon in Mercer County, and Children's Hospital of Pittsburgh -- accept Tricare. Because most hospitals don't accept the insurance, UPMC doctors don't accept Tricare patients.

Mrs. Rohal said lack of answers from UPMC prompted her to take her complaint public. She contacted U.S. Rep. Tim Murphy, R-Upper St. Clair, on Tuesday with plans to contact U.S. Sen. Arlen Specter, R-Pa., and other officials, to pressure UPMC to accept the military insurance plan.

Mr. Murphy said he was appalled to learn that UPMC accepts elderly patients on Medicare, whose reimbursement rates are similar to Tricare's, but not active-duty military, their families and retirees.

"We should be finding ways to support and comfort military families and soldiers, not send them a cold letter that says, 'Sorry,' " Mr. Murphy said. "This situation is not satisfactory or acceptable."

He said he's scheduling a meeting with UPMC officials to get answers.

Mrs. Rohal said she received a voice-mail message Tuesday from a UPMC official who said it was unlikely UPMC would accept Tricare due to its reimbursement rate.

But Frank Raczkiewicz, UPMC spokesman, said the health system now is considering joining the network.

"As demand grows for this, we're addressing the issue," Mr. Raczkiewicz said. "We are going to get into discussions with Tricare so we can expand the coverage system-wide."

The surprise news delighted Mrs. Rohal: "I think it's great if they get it to happen soon."

Molly Tuttle, spokeswoman for Health Net Federal Services, which administers the Department of Defense's Tricare insurance program in the North region, also said it was "excellent news."

Ms. Tuttle said Health Net officials unsuccessfully contacted UPMC twice a year for the past five years to persuade it to join the network. While soldiers and their families can get treatment at any UPMC facility, there they would be assessed higher out-of-pocket expenses.

There's no government mandate requiring hospitals or medical facilities to accept Tricare, she said.

"They are a business," Ms. Tuttle said. "They can choose what health-care insurance companies they accept. Unfortunately, it's not Tricare. They are in the driver's seat as to whether they accept Tricare patients."

The West Penn Allegheny Health System, the region's other health-care provider -- including West Penn and Allegheny General hospitals and the West Penn Forbes Regional campus in Monroeville -- accepts Tricare.

"West Penn Allegheny understands the burden placed upon those who serve and those who have served this great country during time of crises," spokesman Dan Laurent said. "We are in the midst of two ongoing wars as well as the severest recession since the Great Depression. We will continue to accept Tricare patients as we have in the past."

Health Net's network includes 125,630 hospitals, medical centers and physician groups, with ongoing negotiations to expand it for the convenience of military families.

Health Net's coverage area extends from Maine to North Carolina and as far west as St. Louis. It and two other Department of Defense Tricare contractors, Humana Military in the South and TriWest out West, supplement the military health care system so military personnel, families and retirees can use civilian medical services.

"We're working hard to continually provide more choices for active-duty members and their families in all areas, and in the last five years we've doubled the size of our network," Ms. Tuttle said. "We'd love to have UPMC as a network provider."

Correction/Clarification: (Published 2/12/2009) All University of Pittsburgh Medical Center hospitals accept military personnel, their families and retirees who have the military health insurance plan, Tricare. But patients who use UPMC hospitals not in the Tricare network potentially face higher out-of-pocket expenses for medical care. Three of UPMC's 15 hospitals -- Mercy, Children's Hospital of Pittsburgh and Horizon in Mercer County -- are in the Tricare network. This story was unclear about what UPMC's policy is.
David Templeton can be reached at or 412-263-1578.
First published on February 12, 2009 at 12:00 am

Any hospital that takes federal funds of any kind which they all do, should NOT be allowed to turn away Tricare patients because the DOD does not pay enough of the bills that the hospitals think they should pay. Most Tricare enrollees have no choice in what amount Tricare pays, they have to enroll in it as military retirees and dependents for their medical care, and then they must also enroll in Medicare when they turn 62 or 65 despite the promise of "free medical care for life" if their spouses spent 20 years or more on active duty. The greatest lie ever told to millions of military personnel and we all believed them from WW2 until the early 80s when the lie was exposed. This is BS plain and simple

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