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March 30, 1995

Pregnant, seriously ill subscribers may be able to continue treatment with HealthAmerica physicians

Chancellor O'Connor's decision to make Blue Cross of Western Pennsylvania the exclusive provider of employee health insurance at Pitt means that 5,100 University employees, spouses and children currently enrolled in HealthAmerica will have to switch to the Blues effective July 1.

For many of the employees and their families, the change will mean finding new, Blue Cross-affiliated doctors to replace their HealthAmerica physicians. But Pitt HealthAmerica enrollees who are pregnant or being treated for serious illnesses may be able to keep their HealthAmerica doctors at least until their current treatment programs are completed.

Under an appeals system that Pitt's Human Resources office is drafting, such HealthAmerica members would ask their HealthAmerica physicians to write letters explaining the importance of continuing the current treatment program and physician-patient relationship beyond July 1.

Human Resources and Blue Cross would review each request. "We (the University) would make the final call on whether to honor the request," said Darlene Lewis, Pitt associate vice chancellor for Human Resources. "If we're going to err in making these decisions, we're going to err on the side of granting the employee's request when it's truly the humane thing to do." Pitt hasn't approached HealthAmerica yet with the plan, Lewis said.

She noted that employees with serious health conditions tend to work with specialists (many of whom may be affiliated with Blue Cross as well as HealthAmerica) rather than the primary care physicians employed exclusively at Health-America centers.

Lewis emphasized that exceptions will be limited to cases of pregnancy and acute illness. "You won't be able to keep your HealthAmerica physician (after July 1) just because you prefer dealing with that particular doctor," she said. And the relationship with the HealthAmerica doctor would be limited to the pregnancy or illness specified. All other medical care would be provided through Blue Cross and employees would have to formally enroll in a Blue Cross plan, Lewis said.

Just how long a Pitt employee could continue his or her HealthAmerica treatment beyond July 1 isn't certain. "Six months would be our general guideline, but in some cases it could be longer than that," Lewis said.

It's also uncertain whether HealthAmerica will agree to the arrangement. Mike Blackwood, president and chief executive officer of HealthAmerica, said his company will consider letting its physicians participate "under the right circumstances." "Am I willing to talk about it? I suppose I am," Blackwood said. "But I'll do it for the patients' sake. What I won't stand for are any arbitrary decisions by the University about who's treated and who's not. If they (Pitt administrators) are going to overrule the doctors, I won't put up with that." Blackwood said he finds it "extraordinary" and "irresponsible" that Pitt officials are only now looking into a continuation-of-care plan. "Basically, this (plan) would allow the University to have a soft landing for what is, as far as I'm concerned, a very irresponsible action" in giving Blue Cross sole provider status. "The University is saying, 'It's okay for us to compromise the patient's care, it's just not okay for you (HealthAmerica) to do so.'" University Senate President James Holland said he found the Human Resources plan "a little comforting, but not much. There are people who are scheduled for surgical operations and such (through HealthAmerica) after July 1, and it's good to know they'll be able to go through with them. But there are also plenty of HealthAmerica subscribers like me who are being treated for high blood pressure and similar conditions. High blood pressure is something you get treated for for the rest of your life, not just a specific number of months. I doubt that people like me with those kinds of conditions will be allowed to maintain their relationships with their (HealthAmerica) physicians." Holland and Associate Vice Chancellor Lewis said they have received numerous letters, telephone calls and e-mail messages from Pitt HealthAmerica subscribers expressing anguish at being forced to find new doctors. Some of the subscribers suffer from rare disorders requiring special treatment, Lewis and Holland said.

"A number of the letters have been very moving, and they were written by the kind of people we're trying to protect with this (continuation-of-care) plan," Lewis said. Holland said, "It's going to be a wrenching experience, breaking relationships that people have built up with their HealthAmerica doctors over 20 years. It's a life crisis. It's like a divorce."

— Bruce Steele

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