University Times

TO: All HealthAmerica Participants

As of July 1, 1995 HealthAmerica is not a University of Pittsburgh medical provider, except under limited circumstances.

The April 14, 1995 letter you received from HealthAmerica indicating that you may select and continue to utilize your HealthAmerica doctor(s) is extremely misleading — particularly concerning additional costs. There is no way that HealthAmerica or the University can guarantee your financial liability.

If you choose the SelectBlue, UHN, or Comprehensive Plan, you may go "out of network" and visit any doctor that you wish, even if the doctor is a sole HealthAmerica provider. However, please remember: — Unless you waive coverage, you must enroll in one of the University of Pittsburgh's Blue Cross medical plans to receive continued medical benefits.

— You may apply your "out-of-network" expenses to your annual Blue Cross deductible. Remember, Blue Cross will reimburse only you (not HealthAmerica) and you will be reimbursed only at the Usual, Customary, and Reasonable allowance. For example, HealthAmerica charges you $120: HealthAmerica waives 20% or $24.

You submit a bill to Blue Cross for $96.

Blue Cross reduces the $96 by its allowance and subtracts a 20% co-payment.

If you have not reached your Blue Cross deductible, you will receive no reimbursement from Blue Cross. You will owe HealthAmerica $96.

If you have reached your Blue Cross deductible, you will owe HealthAmerica the difference between the $96 and the Blue Cross reimbursement.

— HealthAmerica stated in their April 14, 1995 letter that they will set up a "fee structure" for any services rendered by a HealthAmerica doctor. Since there is no contract between HealthAmerica and you, their fees can be altered at any time, at their discretion. The University has negotiated a guaranteed rate with Blue Cross for the life of the contract.

— At a meeting on April 13, 1995 with HealthAmerica, it was agreed that Transition of Care would be provided to you and your dependents, who may be under treatment for a serious medical condition. The Keystone HMO plan is very similar to HealthAmerica. Keystone has no co-payments for medical visits and mental health. Prescriptions under Keystone are $2 for generic and $8 for brand name.

The Blue Cross/Blue Shield Health Center at the University of Pittsburgh Medical Center (opposite the Holiday Inn on Bigelow Boulevard) will be a full service walk-in facility similar to, however larger in scope than HealthAmerica's Sterling Center. At the new Center not only will physicians from UPMC be available on an emergency basis, you will have the option of selecting your Primary Care Physician at that location. The Center is accessible to subscribers of all University of Pittsburgh Blue Cross medical plans. Furthermore, physicians from UPMC, Magee-Womens Hospital, and Children's Hospital will be setting up practice and supporting the University community.

Darlene Lewis

Associate Vice Chancellor, Human Resources