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June 11, 1998

New medical, dental plans pose problems at Bradford, Titusville

Pitt's new health care and dental benefits options, which go into effect July 1, are posing problems for some employees at the Titusville and Bradford campuses.

Bradford employees are upset by what they perceive as restrictive health care choices, due to their proximity to New York State, where some employees' primary care physicians are not covered by any of Pitt's health care options.

At Titusville, the concern is with dental options. Only two dentists in a two-county area participate in the less expensive of the two United Concordia dental plans Pitt will have, and neither dentist is located within a half-hour's drive of UPT.

Pitt administrators say they are doing what they can to alleviate the problems.

Ron Frisch, vice chancellor for Human Resources, and Jim Edgerton, director of Compensation and Benefits, brought representatives of Highmark and Tri-State Health System (for medical benefits) and United Concordia (for dental benefits), to each of the four regional campuses during open enrollment to present options and address concerns.

A second session is scheduled for today at Bradford, where vendors will be on hand to answer questions and provide one-on-one counseling. The open enrollment period at both Bradford and Titusville has been extended to the end of June.

Frisch said he was aware early on of the dilemma of employees seeking to use health benefits in New York State.

"We made a proposal to the New York Highmark group, I think back in March or earlier, but they were unreceptive. Negotiations for health care and reciprocal benefits [across-states] are usually done on a state-wide basis. A typical benchmark is to have 50 or more willing and eligible participants, not counting family members, and we could not raise that many individuals. We did announce that at the [Bradford] benefits fair."

Edgerton said that HMO Tri-State Health System is addressing staff concerns by expanding the number of doctors eligible under Tri-State's health plan in the Bradford area by about 35. Local options at least are being expanded, Edgerton said. "These doctors, who practice in the Bradford area, are in the process of being credentialed right now, and we hope to present a list to employees at the [June 11] benefits presentation or very soon after," he said.

Regarding the dental benefits issue at Titusville, Frisch said that in Crawford County there are 40 dentists, 29 of whom are participating in the Concordia contract. Venango County has 30 dentists with 19 participating, he said. The figures were provided by United Concordia, with whom Pitt is contractually obligated for two years beginning July 1.

Titusville is located in Crawford County near the border of Venango County.

Debbie Biggerstaff, director of Human Resources at the Titusville campus, does not dispute the numbers, and recognizes the good-faith efforts of her Pittsburgh counterparts. "They listened and they were very cooperative and concerned," she said, referring to Human Resources representatives at the Titusville benefits fair.

The problem, Biggerstaff explained, is that none of the Crawford County dentists will participate in the less expensive Concordia/Managed Care plan. Even in neighboring Venango County, there are only two dentists who will participate in this less expensive option, she said.

The difference in the options is significant, employees note. Rates for individuals in the Concordia/FLEX plan are $15.41 per month, with a $50 deductible and $500 per year maximum versus the Managed Care plan's $11.54 monthly rate, with no deductible and no yearly maximum.

To further complicate matters, the most convenient and heretofore most popular dental office, Titusville Dental Arts Clinic, opted not to participate in either of the Concordia plans. "My understanding is that they were contacted by the Concordia representatives — and even some staff members during visits — to get them to sign up," said Biggerstaff. "I think who 'dropped the ball' here were the Concordia representatives, not Human Resources. I would question their (Concordia's) presentations."

The nearer of the two Managed Care plan dentists is at least a half-hour away, Biggerstaff said.

The Titusville campus employs 45 staff members and about 50 full- and part-time faculty.

Frisch acknowledged the problem, but said, "It really is up to the individual dentist to make the determination of joining or not joining a particular plan.

"What they decide [by joining] is they will abide by determined rates, as set by an insurer. Say the extraction rate is set at $50. But, they may say, 'No, an extraction is really $65, and we're losing money.' "I don't know that we'll ever get managed care dentists to join in any significant numbers." Edgerton noted that part of the issue is the volume of participants, because a dentist would be more likely to join a managed care plan if a large number of people would become patients as a result.

In an effort to avoid similar problems, staff from the regionals are seeking representation on the next committee negotiating health care options for Pitt personnel.

Regarding such representation, Frisch said, "I'm all for it. I will recommend to Jerry Cochran that there be more staff representation." Cochran, assistant chancellor for Business and Administration, will be assembling that group, probably early in the next fiscal year, Frisch said.

–Peter Hart

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