UPMC Health Plan

I am extremely frustrated that UPMC seems to be the only provider in town because their customer service is horrendous. After needing to take my son to Children's Hospital at the end of March 2013, more than six months after the services, I am still fighting with UPMC Health Plan for an accurate Explanation of Benefits and for them to honor the deducible amounts listed on my insurance plan for this year. I have called UPMC Health Plan more times than I can count and every time I speak with a "concierge" I need to give all details all over again. I think I have spoken with all the "health care concierges" that UPMC employs! The inability to speak with anyone who can provide results is highly frustrating and discouraging. The only department I, the consumer, is permitted to contact is the concierges, but since they have little latitude to be able to resolve problems, the company seems to be an impenetrable behemoth. Furthermore, they have little regard for their consumers. In spite of my constant attempts to resolve their erroneous billing, I have needed to ask repeatedly for collection delays on my account with Children's Hospital. Because UPMC Health Plan seems to deliberately try to take the longest period possible to respond, my account with Children's has nearly gone into collections status. It was only after I demanded that someone from UPMC take ownership to speak with the billing department at Children's, that Children's agreed to place a hold on our account "pending investigation". It's my credit on the line, but UPMC Health Plan's sheer disregard to expedite anything is infuriating at best. If I wasn't forced to use UPMC (because it's the only health coverage offered by my husband's employer), I wouldn't.

UPMC approved several necessary tests that are not normally required for a 30 year old. I have an excellent insurance plan which I pay a premium price for, so I was glad that we didn't have to fight very hard to get approval on a barrage of tests to a**** an abnormal condition. Thankfully, all tests showed a relatively clean bill of health, but it's good to know that UPMC trusts the doctors in their assessment of what test are necessary.

I am extremely frustrated that UPMC seems to be the only provider in town because their customer service is horrendous. After needing to take my son to Children's Hospital at the end of March 2013, more than six months after the services, I am still fighting with UPMC Health Plan for an accurate Explanation of Benefits and for them to honor the deducible amounts listed on my insurance plan for this year. I have called UPMC Health Plan more times than I can count and every time I speak with a and quot;conciergeand quot; I need to give all details all over again. I think I have spoken with all the and quot;health care conciergesand quot; that UPMC employs! The inability to speak with anyone who can provide results is highly frustrating and discouraging. The only department I, the consumer, is permitted to contact is the concierges, but since they have little latitude to be able to resolve problems, the company seems to be an impenetrable behemoth. Furthermore, they have little regard for their consumers. In spite of my constant attempts to resolve their erroneous billing, I have needed to ask repeatedly for collection delays on my account with Children's Hospital. Because UPMC Health Plan seems to deliberately try to take the longest period possible to respond, my account with Children's has nearly gone into collections status. It was only after I demanded that someone from UPMC take ownership to speak with the billing department at Children's, that Children's agreed to place a hold on our account and quot;pending investigationand quot;. It's my credit on the line, but UPMC Health Plan's sheer disregard to expedite anything is infuriating at best. If I wasn't forced to use UPMC (because it's the only health coverage offered by my husband's employer), I wouldn't.

I had been seeing the same out-of-network provider for over a year, and submitting claims for reimbursement after each visit. I had a great deal of trouble getting these claims to be processed correctly. I had to call about almost all of the approximately 15 claims for this provider.
I spent over 8 months attempting to get the date for one visit corrected. Each time, a supervisor would assure me that it would be corrected, but each time, it was left the same and I was forced to call again. I had representatives assure me they would call when aspects of some of the claims were corrected, but they never did. I had mailed claims go missing, and when I re-faxed the claims, they would sit on a supervisor's desk for months after they assured me it would be taken care of and quot;right away.and quot;
I would use this insurance provider again, but basically because I am forced to. I was seeing this out-of-network provider because I was ill; having to deal with the nightmare of paperwork and mistakes behind the scenes made it feel as if I was twice as sick.

This is a mixed report, not because services were unsatisfactory, but because the presentation of a new plan was poorly done.
We have a choice of health insurance providers, and we changed to UPMC a few years ago because the insurer we were using had raised its rates so high. During the first two years with UPMC, everything was fine. Then, with little warning, a new plan was sprung upon us for the current year. The new plan was confusing, and they did a very poor job of assisting with the transition. Had we been given sufficient information beforehand, we would have at least considered other plans--including those with UPMC.
However, once we muddled our way through, using poorly designed web sites to get started, we were not so unhappy with the plan. Its emphasis is on engaging covered members to improve their lifestyle in order to minimize health problems--and reward them for doing so.
While certain aspects of the plan are not well thought out, overall it is okay. For example, there is a lengthy personal questionnaire that each member must complete in order to get credits towards your co-insurance and co-pays. It does not allow for the individual to be retired! Therefore, you are forced to answer questions about your job, even though you don't have one.
There are several web sites with slightly overlapping uses. And, at least one of the incentives is ridiculously difficult to achieve. I am referring to losing weight. My husband and I have both changed our eating habits and altered our lifestyle in order to lower our weights. Both of us are being successful, but are not going to get credit for this because we did not start with a plan chosen through a UPMC weight counselor. I started trying to comply and completed a lengthy series of educational on-line programs. After spending hours on this, and being far from completion, I gave up. There is a web site where you are expected to enter what you eat, but I have been doing that for myself. I believe this would then be reviewed by a weight counselor for further recommendations. Since I am having success with what I am doing, I feel that the results should speak for themselves.

The UPMC representative was efficient, knowledgeable and friendly in answering my questions. I have been very pleased with the service from the UPMC Heath Plan.