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January 11, 2001


I have again become involved in a UPMC Health Plan issue. The current problem is the high volume of errors in the plan's explanation of benefit forms (EOB). A number of plan beneficiaries have shared with me difficulties they have encountered because of such errors. I mentioned these EOB problems at the last two Faculty Assembly and Senate Council meetings. The errors are denials of coverage, or of full coverage, under the HMO plan and the point-of-service plan. These errors place medical expenses on plan members, rather than on the plan, and have increased in volume because health benefits for Pitt employees now are available only from the UPMC Health Plan.

Steps have been taken to deal with this problem — the dedicated plan phone line for Pitt employees to present their problems; the opportunity for Pitt employees to meet with a plan representative on campus. But the problems continue. In some instances, after a problem seemingly is resolved, it recurs.

In November I asked Don Williams, the plan's manager of the Pitt account, whether the errors were part of a plan strategy to shift costs to its beneficiaries, or the result of a severely deficient information system. He assured me that the plan's errors in its favor were not intentional; he did admit problems with its information system.

In December, a high University official asked me why employees contacted me about their plan problems. I answered that those who contacted me were frustrated because of the erroneous EOB forms, continuing to have to deal with plan representatives to straighten matters out, and that help from Human Resources was limited to telling them to contact plan representatives. The University, particularly Human Resources, has not been sufficiently aggressive on behalf of the University's employees. It is in the University's interest to get tough. After all, most of the time spent on the phone dealing with the plan is during the Pitt employees' workday, time that could be spent on Pitt business.

An employer that provides employee health benefits recently asked for my thoughts about switching from Highmark to the UPMC Health Plan. Premiums would be substantially less. I related my experiences, and those of Pitt employees, with plan performance, and told this employer that it should not ignore the time its employees would use to deal with benefits problems, and weigh its value against the premiums saving.

Improving the information system quickly is in the interest of the plan, Pitt employees and the University. Perhaps a few of the many dollars spent on media to extol the virtues of the plan and its lack of interference with provider-patient relations could be directed to the information system. Also, Pitt should insist on some performance standard for the plan's handling of benefit claims, and for a financial penalty on the plan when the error rate in its favor exceeds the specified standard. Finally, data concerning plan failings should be transmitted to the appropriate Commonwealth regulating body, which might pressure the plan to do better.

q The response to the planned Feb. 15 special plenary session, "The Open University: Is Pitt Open Enough?," has been disappointing. Relatively few requests to speak at the plenary session have been received. The Senate's officers may decide, unless we receive more requests to speak soon, to cancel this plenary session. Perhaps we have misjudged the amount of interest of Senate members in the subject; perhaps Senate members are timid about publicly addressing an issue in a way that might be viewed as critical of how Pitt operates. I encourage any Senate member who wants to participate to promptly send a precis of what he or she would say to the Senate office. A decision will have to be made before the end of January on whether to cancel.

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