Business Profile

Clinic

UPMC Health Systems

This business is NOT BBB Accredited.

Find BBB Accredited Businesses in Clinic.

Complaints

This profile includes complaints for UPMC Health Systems's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

41 total complaints in the last 3 years.
18 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:02/09/2024
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On 5-4-23, I attended a dermatologist appointment. I was charged a $15 co-pays that I shouldn't have had to pay. The insurance coverage that I had at the time paid their parts. I discovered this during a phone call to UPMC for You on 9-18-23. I requested to begin the reimbursement process. I followed the instructions and submitted all the necessary paperwork. After several months of wild goose chases and procrastination letters, I learned that the claim was not submitted in a timely manner. "Timely Filing of 180 days from the initial payment." NOT a SINGLE UPMC concierge that I spoke with from September of last year until now mentioned ANYTHING about timely filing! The first concierge that I spoke said there wasn't a time limit! I wasted months of back and forth on this matter! No one knew of this?!? I don't want scripted apologies and flowery mantras. I WANT my co-pay reimbursed. They also NEED to be upfront about ALL policies! (All of the claims and conversations are on file with UPMC. If need be, I can mail a copy that receipt in case the photos are not clear.)
Business Response
Date: 03/06/2024
Dear ***** ******:

This is UPMC’s response to the complaint filed under Better Business Bureau ID number *********

The patient’s $15 copayment was refunded back to the credit card used to make the original payment. This was completed on March 5, 2024.

We thank you for this opportunity in allowing us to review and resolve this patient’s concerns.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 03/06/2024
** ******* ****** ** ******** **** ***** ********* **** ********** ** *** ********** ********* ** *** ***** *** *** ****** ** ****** ******* ****
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Regards,

******* *******
Initial Complaint
Date:12/31/2023
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
The service coordinator, Carrie B***** has been a nightmare to deal with. Not only the arrogance in the way she speaks to myself and to my mother (ie: talks to us as if we are children and do not understand a thing), but, the many other issues such as not obeying doctors letters due to immunocompromised/immunosuppressed conditions, etc. We want to leave UPMC entirely and want nothing furthermore to do with them. My mother wants left alone as it is her right in Pennsylvania under law. Stop harassing both of us, especially my mother, and leave us alone.
Business Response
Date: 01/11/2024
UPMC Health Plan, Inc. (“UPMCHP") has received and reviewed your letter dated January 1, 2024, as well as the Authorization to Release Health Information. Please accept the following as UPMCHP's response to your letter and the accompanying complaint filed by ***** ******** on behalf of her mother, ****** ********. According to our records, ****** ******** was enrolled in a UPMC Community HealthChoices ("CHC") plan, a Medical Assistance product offered by UPMC for You, Inc. In Ms. ********'s complaint, she expresses dissatisfaction with the process by which the assessments have been conducted for her mother regarding her Personal Assistance Services ("PAS") hours. She is requesting to discontinue the PAS that her mother is currently receiving through UPMC CHC.
As a general matter, UPMC CHC offers PAS, which are designed to provide hands-on assistance to participants with their Activities of Daily Living. These services may include help with activities such as bathing or dressing as well as routine support services such as meal preparation or grocery shopping. PAS hours may be authorized following the participant's completion of a comprehensive needs assessment, which is required by the Department of Human Services (“DHS”) and is generally conducted by a UPMC CHC Service Coordinator both in-person and telephonically. Information recorded in the assessment may include details related to the participant's living situation and informal supports and is based on both the participant's self-report as well as any observations made by the Service Coordinator during the assessment. Once the assessment is completed and PAS hours are approved, they are staffed by a direct care worker (“DCW”) and can be used in any manner to best meet the participant's needs. Shifts are generally scheduled around the participant's schedule and can be split up between caregivers or even split up throughout the day.
According to our records, Ms. ******** serves as the DCW and staffs the approved PAS hours for her mother. In preparation for her mother's most recent needs assessment, she requested UPMCHP minimize the amount of in- person contact due to her mother's health condition and provided documentation from her mother's PCP in support thereof. UPMCHP made the necessary arrangements to accommodate this request. After two unsuccessful attempts to conduct the virtual assessment, on November 13, 2023, UPMCHP and Ms. ******** were unable to establish a video conference and attempted to conduct the assessment telephonically. Because some necessary portions of the assessment required direct access to Ms. ********, UPMCHP made the appropriate arrangements to conduct the remaining portions of the assessment in-person on November 20, 2023. During this visit, the Service Coordinator remained outside, masked, and distant from the participant. Following the needs assessment, the participant's PAS hours were reduced which prompted Ms. ***** ******** to contact UPMCHP with concerns about the number of approved PAS hours. Upon further review of the participant's case, UPMCHP identified potential discrepancies with the DCW timecards that were being submitted. When the UPMC CHC Service Coordinator contacted Ms. ******** to explain this matter, she expressed her general dissatisfaction with the benefits being offered by UPMC CHC and requested her mother's PAS hours be discontinued as of January 7, 2024. Further, since that contact, Ms. ******** has indicated her mother's intent to switch to a new Managed Care Organization ("MCO”) near or around February 1, 2024.
UPMCHP maintains that it followed the appropriate policies and procedures as well as applicable DHS guidelines related to conducting the assessments to determine the appropriate PAS hours to approve for Ms. ********'s mother. UPMCHP further maintains that it attempted to accommodate the requests of Ms. ******** regarding minimizing in-person contact during the most recent assessment. Ms. ********'s mother is free to switch MCOs or discontinue her enrollment with UPMC CHC. Once the participant is disenrolled from UPMC CHC, UPMCHP will no longer be involved in the assessments or approvals of PAS hours for Ms. ********'s mother. Should you have any further questions, please do not hesitate to contact our offices.
Respectfully Submitted,

Anthony P*******, Esq.
UPMC Legal Department UPMC Health Plan
Initial Complaint
Date:12/05/2023
Type:Billing Issues
Status:
UnansweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Nov 16, 2023 I was charged a $15 fee in order to use a portal for a video visit with my provider. The date of service was also that date. I never requested a video visit as I scheduled the office visit about 8 weeks in advance. I was called that morning and told that my appointment was being made a video visit & I would have to go through the portal. I was required to pay $15 online before I could proceed. To be clear, the video visit was for the convenience of the doctor. I called **** Health Plan (the insurance carrier) immediately & was told to file an appeal once the claim was processed. Following up, the **** ******** Advantage Plan said that the **** *************** submitted the claim as zero co-pay. However when I called UPMC Customer Service I was told that the $15 was a co-pay. So is this fraudulent? Who do I contact since it's not an insurance complaint but is specific to improper billing of a ******** insured? UPMC Customer Service has not been helpful.
Initial Complaint
Date:10/31/2023
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On May 1, 2023, I went to my PCP. Comprehensive Care Associates for a pre surgical physical. I paid a co-pay of 25 dollars. Upon UPMC billing me for more money for the visit, I called and found out that I should have given my workers compensation information for the visit. I provided the correct insurance information and UPMC was paid in June. The first representative I spoke with said that once UPMC was paid, I would receive my 25 dollars back. I’ve called no fewer than three times and UPMC refuses to give me my money back. On two different occasions, I’ve been told that I am scheduled for a refund and they haven’t paid me. When I owe UPMC money, they are all over me like a rash and I would have been sent to collections by now. This is a big corporation deliberately being obtuse because I have no power. I would like my money back.
Business Response
Date: 11/08/2023

This is UPMC’s response to the complaint filed under Better Business Bureau ID number ********. This complaint was originally mailed by the BBB to ***** ****** at the UPMC Health Plan. M** ****** forwarded the complaint to the UPMC Revenue Cycle for follow-up.

Upon receipt of the patient’s concerns, the accounts were reviewed.

The patient’s workers’ compensation coverage was added to the account and billed. The patient’s refund was processed on October 25, 2023. UPMC Revenue Cycle Patient Relations spoke to the patient on November 2, 2023, to communicate the refund information.

We appreciate the opportunity to provide this response and apologize for the inconvenience experienced by the patient.

Customer Answer
Date: 11/08/2023
** ******* ****** ** ******** **** ***** ********* **** ********** ** *** ********** ********* ** *** ***** *** *** ****** ** ****** ******* ****
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********* and find that this resolution is satisfactory to me.

Regards,

****** *****
Initial Complaint
Date:10/25/2023
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Can not get them to finish filing the refund for my prescription I paid out of pocket. It was not properly authorized and I initiated the steps myself. They are unwilling to help or take the lead in any part and as sick as I am, I am making all the phone calls with my autism raging and my health flailing, my copraxia triggered and unable to maintain a good face. This is stressing me out and now I have two other forms to be refunded for, 15.00 a piece (originally 39.95) for items covered by the OTC app but not rang up as covered at Walmart. I am highly aggrivated and getting no help. The amount I paid out of pocket is 70.00 for ten suppositories. The pharmacy is going out of business at the end of the month. I will file a lawsuit next with the ADA. I want my refunds, contact by the highest management and thorough review of ALL the calls I made to the insurance and a proper hand written and snail mailed apology.
Business Response
Date: 10/26/2023
Dear Ms. ******,

We are in receipt of the complaint reference ID ********.

Please note there is no HIPAA release attachment with this complaint; therefore, we cannot proceed with our review at this time. We ask that the complainant provide his/her signature on the HIPAA release form and return to us so we may begin our review of his/her complaint.

Warm Regards,

UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 10/26/2023
See attached.
Business Response
Date: 11/04/2023
Under Medicare Part D, a "coverage determination" is a determination made by a Medicare Advantage Part D (MAPD) or Part D Plan (PDP) sponsor with respect to a member's benefits, coverage or the amount the MAPD or PDP will pay for a medication.1 A specific type of coverage determination is an "exception request" — a request from a beneficiary or their provider to cover a medication that would otherwise not be a covered benefit or to cover a medication on a lower cost sharing tier. This includes a formulary exception, which is a request for coverage of a medication that is not on the plan's CMS-approved formulary. An exception request must include a supporting statement from the prescribing physician indicating why the non-formulary medication is medically necessary in order to be approved.
According to our records, Ms. ****** contacted UPMC for Life Complete Care Member Services on October 20, 2023 and indicated that she had been unable to receive the medication Promethazine 25 MG Suppository at the pharmacy. The representative informed her that the medication had denied because it was non-formulary, and as such would require an exception request. The representative then submitted a request for the medication, and advised Ms. ****** that if she paid out of pocket and the coverage determination was approved she would be able to request reimbursement.
On October 25, 2023, Ms. ****** outreached to UPMC for Life Complete Care again and stated that she paid out of pocket for the prescription Promethazine 25 MG Suppository. The representative informed the member that her exception request was still open at that time, and that the outreach had been made to her provider for more information, specifically regarding her diagnosis and a list of past medications that she had tried and failed, but they had been unable to contact them. The representative also informed the member that her primary care physician would need to contact UPMC for Life Complete Care to provide the necessary information. On the same day, Ms. ****** submitted this complaint with your office.
The following day, a Notice of Denial of Medicare Part D Prescription Drug Coverage was sent to Ms. ****** informing her that her exception request for Promethazine 25 MG Suppository had been denied. The denial notice stated that there were formulary drugs available to treat her condition, including prochlorperazine rectal suppository. Additionally, it noted that her provider did not submit a supporting statement indicating that she had tried and failed the formulary medications or was otherwise unable to use the formulary drugs, a requirement for approval of the request. Ms. ****** spoke with a UPMC for Life Complete Care representative on the same day and was informed of the denial.
As noted above, Ms. ****** paid out of pocket for the medication Promethazine 25 MG Suppository. UPMC for Life Complete Care is not able to reimburse members for non-formulary medications without an approved formulary exception on file. An exception request can be made retroactively; however, Ms. ******'s previous request was denied on October 26, 2023. As of today's date, we have not received a reimbursement request from the member, nor has she appealed that denial. UPMC for Life Complete Care Member Services outreached to Ms. ****** on October 31, 2023 to assist her in filing a reimbursement request but was unable to reach her at that time.

For the 2023 plan year, UPMC for Life Complete Care offers as a supplemental benefit the UPMC for Life Shop Health Card, a Value-Based Insurance Design (VBID) program. This is a $400 quarterly allowance can be spent on covered over-the-counter (OTC) health care products and healthy foods. The Shop Health Card allowance can be used for OTC products purchased in-store at participating retailers and through UPMC for Life's mail order catalogue. Members can also purchase OTC products online through UPMC for Life's secure member website, MyHealth OnLine (MHOL). Healthy groceries are covered in-store at select participating retailers.
Ms. ******'s concerns regarding her Shop Health Card have been referred to our SNP Operations department. Occasionally, eligible OTC products may not be recognized by a participating retailer's system. If Ms. ****** paid out of pocket for eligible products, she may submit a request for reimbursement. After providing a copy of her receipt, she may submit for reimbursement via the mobile app, member portal, or through mail-in form. A copy of a UPMC for Life Shop Healthy Card reimbursement request form has been included with this response for her reference.
Initial Complaint
Date:08/18/2023
Type:Billing Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
In April, I scheduled a visit solely for a routine physical, which is included in my insurance benefit. I discussed this when scheduling the appointment. After the appointment, I received a large bill. Even though I was very clear about my coverage, they scheduled me with a different doctor (since mine was not available) and did not disclose that this particular doctor was out of network, even though I regularly see doctors in that facility that are in network. They fixed this issue. I received another bill for a copay. I called to address and discovered that they are now billing me for 2 different visits on the one visit. They have me in for my physical and for an 'office visit'. Trying to bill me and the insurance company twice for the same visit (when only a physical was discussed and scheduled) is fraudulent! I have had numerous employees tell me they will look into resolving and get back to me and no one ever does. Stop harassing me for a copay for a fraudulent visit!
Business Response
Date: 08/30/2023
Dear *** ******,
This letter is in response to your complaint filed with the Better Business Bureau (BBB), regarding billing a fraudulent office visit provided by Dr. Deborah M******, at UPMC Susquehanna Trail Family Medicine on April 13, 2023.

In the complaint filed by Mr. *******, he states we are trying to bill him twice for one visit. Mr. ******* did schedule his routine preventative care visit on April 13, 2023. An office visit can be billed on the same day with a preventative care visit if the problems are significant enough to require additional care to be performed. During Mr. *******’s routine preventative care visit multiple issues/problems were discussed. Since these conditions were addressed, Dr. Deborah M****** ordered additional testing and a referral to a specialist provider for Mr. *******. These charges are accurate and appropriate for Mr. *******’s care. UPMC Central Pa is not fraudulently billing Mr. ******* for an office visit.

Mr. ******* also states in his complaint that after his appointment he received a large bill from UPMC Central Pa. UPMC Central Pa is participating with Aetna, so there was not out of network billing.  The patient responsibility assigned by Aetna was a $20.00 office visit co-pay applied as in network. Mr. ******* received a statement from UPMC Central Pa dated May 6, 2023, for $20.00, which is his office visit co-pay. Mr. ******* received two additional statements dated June 1, 2023, and August 2, 2023, for his unpaid $20.00 co-pay.

Mr. ******* contacted UPMC Central Pa Customer Service on June 1, 2023, concerning his charges on April 13, 2023. Customer Service sent his concern for review. In his complaint, he states no one responded, Customer Service contacted Mr. ******* and left a voicemail on August 1, 2023, when his review was completed. Mr. ******* was advised the provider’s office reviewed and determined the charges and coding are appropriate for the visit. He was advised if he has any additional concerns for this visit, he is to contact the provider’s office via the patient portal.

Mr. ******* also states in his complaint that UPMC Central Pa is harassing him for his $20.00 co-pay. This is untrue, UPMC Central Pa’s billing process will send three statements. The initial statement allows 26 days for payment. If no payment is made in 26 days, then a second statement will be sent indicating the account is past due allowing for an additional 26 days for payment to be made. If no payment is made, then a third statement is sent indicating the account is overdue and indicates if payment is not made in 14 days, any unpaid balances will be sent to collections.

Mr. *******’s $20.00 balance was sent to our collection agency, Penn Credit on August 28, 2023. He will need to contact Penn Credit to make his payment.

We hope this explanation resolves the reason why these charges are billed.

Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 09/07/2023
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

UPMC's response was not sufficient and is inaccurate. There was not any significant visit beyond my annual check-up. In fact, I went ABOVE AND BEYOND to stress to the doctor that I was only at that appointment for my checkup and I did not want referrals for any testing that was not included. As a patient/consumer, I couldn't have been any clearer about the intentions of my visit. Can you please provide a breakdown of what was significant enough beyond the check-up I scheduled that justified trying to charge my insurance company (and myself) for a second visit? I am assuming that you have a detailed outline of what is and is not included, otherwise it seems very subjective.
Regards,
****** *******
Business Response
Date: 09/21/2023
Dear *** ******,

This letter is in response to the additional information requested regarding the complaint ID ********* in regard to billing of an office visit provided by Dr. Deborah McCahon, at UPMC Susquehanna Trail Family Medicine on April 13, 2023.

As previously addressed in the original response, an office visit can be billed on the same day with a preventative care visit if the problems are significant enough to require additional care to be performed. Mr. *******’s routine preventative care visit, addressed multiple concerns. During his preventative care visit the following concerns were discussed; anxiety, insomnia; in addition fatigue, chest pain, diarrhea and rectal pain. Lab testing was ordered to properly address his concern of fatigue. A stress test was ordered to properly address his concern of chest pain. A referral to a colorectal surgeon was ordered to address his concern with diarrhea and rectal pain. Anxiety and insomnia were discussed because prescription medication is being taken to treat these conditions. The concerns addressed during his preventative care visit support the additional charge for an office visit during a preventative routine examination.

Mr. *******’s concerns for the charges of a preventative care visit and an office visit have been reviewed serval times. The charges and coding are correct for the April 13, 2023 visit.

Mr. ******* is responsible for the $20.00 co-pay that is being billed according to his benefit plan with Aetna. The original response indicated his balance of $20.00 was sent to Penn Credit Collection agency. He will need to contact Penn Credit to make his payment.

If Mr. ******* would like to request a copy of his medical records, he may request them through the UPMC Patient Portal as he has active portal status.

I hope this explanation resolves the additional concerns why an office visit charge was billed.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 09/21/2023
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

All items discussed were in response to questions asked by the doctor. I was very clear about my intentions of the visit and it is disgusting if my responses to the doctor’s questioning allows you the right for additional billing. In fact, I specified that I only wanted testing that was included with my annual physical. If you look at my medical records, I did not perform any testing that was not a part of the annual physical.
The doctor guided me to responses that resulted in being able to bill me with no notice? Even after I specified to everyone I was only there for my covered annual physical? This seems extremely unethical and I would like someone from the UPMC ethics committee to contact me.

Regards,

****** *******
Initial Complaint
Date:07/19/2023
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Please see the attached file which outlines my claim in full. On October 4, 2022 and subsequently October 5, 2022, I visited a UPMC facility and was treated poorly. I have attempted to contact UPMC on multiple occasions to rectify this issue without any assistance. Please assist me in having this resolved in a timely manner.
Business Response
Date: 09/12/2023
Thank you for your feedback regarding your experiences at the UPMC Lemieux Sports Center - Imaging and Diagnostic Services. The information we receive from our patients and families is carefully reviewed to assist us in identifying opportunities to improve the quality of care we provide. I am sorry you had a negative experience at the practice and in trying to convey your concerns. I am also sorry the additional time required to received needed care caused stress in your professional and personal life. We can and will do better.
I understand that you spoke with Tricia T*****, Director of Operations of the UPMC Lemieux Sports Center. I know Tricia identified an opportunity to send her staff through Medipac training, so that registration can be a smoother and faster process in the future. I know she will also work with the onsite staff to ensure that complaints are passed to her in a timely manner so they can be resolved.
As an academic medical center, we are grateful for the opportunity to learn from patient experiences. Your feedback allows our staff to grow as caregivers through education and accountability. I am confident that future patients will benefit from these insights and improvements.
Please accept my apology for your frustrating experience. We are committed to the continual
improvement of our services and appreciate your feedback; it gives us the opportunity to get better. If you have any other questions, please contact the me at ************.
Sincerely,

Liz L*****
The Wolff Center at UPMC
Customer Answer
Date: 09/15/2023
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

This is a follow-up to UPMC’s response from September 11, 2023, which was in regards to their
attempts to address my complaint originally supplied to the Better Business Bureau of
Pittsburgh (BBB) on July 19, 2023. Upon review, I reject UPMC’s response as being
sufficient and nominal.
While it is accurate that on September 8, 2023, I did speak with Tricia T****** Director of
Operations of the UPMC Lemieux Sports Center, the author of the response letter, Liz L*****,
failed to include pertinent facts of that conversation.
Miss T***** did indicate that new measures and safeguards were put in place to appropriately
educate staff on the technical know-hows and appropriate customer service skills. But she and I
agreed that it would be up to those who receive these types of complaints to address items from
within my initial complaint, primarily related to the failed communication attempts and
recompense for the time missed from work and school - on multiple days - related to the under
trained staff. Miss L***** did not address either of these matters with me directly or indirectly in
her response.
Furthermore, as an academic medical center, UPMC may be grateful to learn from patient
experiences. But there still seems to be a lack of accountability and acceptance of said
instances of gross negligence. Miss L***** failed to address items I was directly advised that
she would address and instead deflected blame elsewhere. Per my initial letter,I lost nearly
four-hours of work and my children were late for school - twice.
In addition, as previously indicated, I reached out on multiple occasions via-phone and through
online submission and not once has UPMC attempted to communicate with me on this matter.
They waited until I sought the assistance of the BBB before contacting me. Nonetheless,
UPMC has yet to provide any form of apology nor offered financial recompense for these
activities. Both of which I am requesting herein and expect.
Your assistance in providing a swift conclusion to my ill-fated visits to this medical provider are
greatly appreciated.
Regards,
****** *******
Initial Complaint
Date:07/03/2023
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
UMPC convinced me to stay with them for 2023 based on the fact I could use my card at Dollar General, Walmart, Several Drug Stores, Giant Eagle, and Walmart.com (as my previous card did work). Dollar General never ended up accepting it and I wasn't told they wouldn't until the end of March. Walmart.com doesn't accept it, and I was only informed that they wouldn't TODAY. But most upsettingly I spent $266 on a health food and beverage order at Giant Eagle only to not have the card working. The supervisor I spoke to at the OTC customer service line was argumentative and apathetic. I want reimbursed, free and clear, for my entire order (I can provide the receipt) WITHOUT it being penalized or deducted from my OTC balance due to the extra hardship this year's OTC program has caused me. I will consider it resolved then, and only then. I was roped into another year with UPMC based on a program they SIMPLY CAN'T fully deliver their promises on. I don't care about the fine print or the C.Y.A. jargon, I care about the LACK OF RESPECT in doing the right thing, the bait and switch. I felt disrespected by the representative and filed a complaint. But since you only handle that internally, I didn't have much faith so I am subsequently filing this BBB report.
Business Response
Date: 07/05/2023
Dear *** ******,

We are in receipt of the complaint regarding Reference ID ********.

Please note there is no HIPAA release attachment with this complaint; therefore, we cannot proceed with our review at this time. We ask that the complainant, William Ainsworth, provide his signature on the HIPAA release form and return to us so we may begin our review of his complaint.

Warm Regards,

UPMC Office of Ethics, Compliance and Audit Services
Business Response
Date: 08/02/2023

UPMC Health Plan, Inc. (“UPMCHP") has received and reviewed your letter dated July 19, 2023, as well as the Authorization to Release Health Information signed by ******* *********. As such, we can offer a response to your letter dated July 4, 2023 and the accompanying complaint. Mr. *********'s complaint relates to issues using his UPMC for Life Shop Healthy Card.
Mr. ********* is a member of UPMC for Life Complete Care (HMO SNP), a dual-eligible Special Needs Plan (D- SNP) offered by UPMC for You, Inc. For the 2023 plan year, UPMC for Life Complete Care offered as a supplemental benefit the UPMC for Life Shop Health Card, a Value-Based Insurance Design (VBID) program. This was a $400 quarterly allowance that could be spent on covered over-the-counter (OTC) health care products and healthy foods. The Shop Health Card allowance could be used for OTC products purchased in-store at participating retailers and through UPMC for Life's mail order catalogue. Members could purchase OTC products online through UPMC for Life's secure member website, MyHealth OnLine (MHOL). Healthy groceries were covered in-store at select participating retailers.
According to our records, Mr. ********* first called UPMC for Life Complete Care Member Services regarding the Shop Healthy Card on January 2, 2023 to inquire regarding his balance. He called again on February 3, 2023, this time requesting information about the status of Dollar General as a participating retailer. The Member Services representative informed him that while it was not a participating retailer at the time, UPMC for Life Complete Care was working to add Dollar General to the program in the future.
On July 3, 2023, Mr. ********* called UPMC for Life Complete Care Member Services again to file a grievance regarding the Shop Healthy Card. Specifically, he stated that he was unable to use the card at Dollar General or ***********. By the time he became aware that he was unable to use his card at these locations, he continued, it was too late to switch plans. In a response dated July 10, 2023, a UPMC for Life Grievance Review Committee noted that while Dollar General was not a participating retailer, he would be able to pay out of pocket at their store and submit his receipts for reimbursement.

As noted above, covered OTC products and healthy groceries are only available for purchase with the Shop Healthy Card in-store from select participating retailers. To purchase OTC products online, members can use the UPMC for Life OTC catalogue through MHOL. We have been unable to locate any calls where Mr. ********* was told that he would be able to purchase OTC products or healthy groceries online at ***********.

1 2023 UPMC for Life Complete Care Evidence of Coverage, 67 (excerpts attached).
2 Grievance Response Letter dated July 10, 2023 (attached).
Additionally, no UPMC for Life Complete Care member marketing or communication materials included this information.
While early UPMC for Life Shop Healthy Card materials listed Dollar General among the participating retailers, due to unforeseen implementation concerns with our Shop Health Card vendor they were not available at the start of the plan year. A letter was sent out to UPMC for Life Complete Care members in December 2022 stating that "Dollar General is not a participating retail store right now, but we are also working to add more stores including Dollar General this year." Following that announcement, plan materials sent to members no longer listed Dollar General as a participating store. However, as noted above, members are still able to purchase OTC products and healthy groceries at Dollar General. They will need to pay out-of-pocket for the covered items and then submit a reimbursement request. A copy of a UPMC for Life Shop Healthy Card reimbursement request form has been included with this response.
Should you have any further questions, please contact me at ************.
Respectfully Submitted,
Steven *. V****, Esq. Staff Attorney UPMC
Customer Answer
Date: 08/02/2023
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

The lawyer who responded FAILED to address the main issue of what occurred to me at Giant Eagle on July 3 that cost me $266 as well as the ineptness of their staff.

Regards,

******* *********
Initial Complaint
Date:12/29/2022
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I received a bill from the above mentioned on 12/29/2022. The date of service was on 6/14/22. This is not the first time that it has taken them 6 months or more to send a bill. They expect their payment promptly, so they should get their billing out promptly.
Business Response
Date: 01/24/2023
Dear ******* *****:

This is UPMC’s response to the complaint filed under Better Business Bureau ID number ********.

Upon receipt of the patient’s concerns, the accounts were reviewed.

Claims for services are prepared and billed to insurance companies. The timing of submission to an insurance carrier and payment by the insurance carrier may be affected by upfront clinical reviews, additional information requests from carriers, etc. For the date of service in question (June 14, 2022), the hospital claim required certain reviews prior to being submitted. However, the claim was submitted within the timely filing requirements of the insurance carrier.

We appreciate the opportunity to provide this response.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Initial Complaint
Date:12/28/2022
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I write to request your assistance with an ongoing issue that I have been having with my healthcare provider, UPMC and my Medicare Advantage Organization, Freedom Blue. I have exhausted the administrative process with both UPMC and Freedom Blue and am still not getting the support or answers I need to understand why a medically necessary medication, Reclast, that had previously been fully covered by Freedom Blue in 2018 and 2020, is now suddenly not being covered. Below is a brief history for your ease of review: In May of 2022, I was prescribed Reclast by my physician. As stated above, this medication was previously prescribed on two occasions and paid by Freedom Blue. This is the only medication that my doctor and I have found that effectively treats my serious osteoporosis; Notwithstanding the history of this medicine being covered, in November of 2022, I received a bill for $5,295. I called the UPMC Billing Department and questioned this bill. UPMC advised that I had consented to this charge. I pulled the “consent form” for this treatment as well as the two treatments before and saw no reference to any disclosure that I would be charged for this drug infusion; On November 30, 2022, I called Freedom Blue and had a lengthy discussion about pursuing an appeal and challenging this charge and this apparent change in Freedom Blue’s coverage; On December 1, 2022, I called UPMC Bedford’s patient access representative, Darla H*****. Ms. H***** was able to find the previous visit information and advised that all three treatments had the same coding. The only difference is that the drug charges in 2018 and 2020 were fully covered but the 2022 charges, with the same exact coding as the 2018 and 2020 bills, was not; On December 20, 2022, I followed up with UPMC Bedford’s patient access because I was concerned that my bill still had not been adjusted and that this might go into collections and impact my credit rating. I also called Stephanie at Freedom Blue and she advised that this was out of their hands because it was a “non-billable charge.” Freedom Blue suggested that I file a complaint against the UPMC provider for billing a non-billable service. Stephanie agreed to assist me in filing a complaint with their resolution department. She also suggested that I reach out to the Better Business Bureau; and On December 21, 2022, I learned that my Freedom Blue appeal was denied on the basis that Reclast is not covered for Medicare patients. I never received any written notification of this denial. As an aside, I was on Medicare for each of the two prior times this medication had been covered. I would greatly appreciate your assistance in getting this complaint resolved. I am caught in the crosshairs of a cumbersome and complicated medical bill review process and have yet to find anyone who fully understands why my claim was denied when all of the other claims for the exact same medication were allowed. I have done everything I am required to do, have pursued all available appeals and I now respectfully request your assistance in bringing this matter to closure. I ask only that this claim be treated the same as the two that were covered by Freedom Blue in 2018 and 2020 and that the 2022 bill for Reclast be adjusted and fully covered by Freedom Blue. At no time did UPMC advise that my medication would not be covered and at no time did Freedom Blue advise that they were changing their coverage of Reclast. Please feel free to contact me should there be anything further you require in order to resolve this dispute.
Business Response
Date: 12/28/2022
Dear Ms. *****,
Please note Ms. ****** did not submit a signed HIPAA release form for our organization to properly address all of her concerns. Without the signed HIPAA release form, we cannot proceed with our review at this time.
We ask that Ms. ****** submit the signed release form.
Sincerely,
UPMC Office of Ethics, Compliance and Audit Services
Customer Answer
Date: 01/06/2023
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.

Please see attached, signed release form.

Regards,

****** ******
Business Response
Date: 02/06/2023
Dear ******* *****:

This is UPMC’s response to the complaint filed under Better Business Bureau ID number *********.

Upon receipt of the patient’s concerns, the accounts were reviewed.

Upon confirmation from the patient’s insurance carrier, the charge in question was adjusted as non-billable.

An itemized statement will be provided to the patient as documentation of the adjustment.

We appreciate the opportunity to provide this response.

Sincerely,

UPMC Office of Ethics, Compliance and Audit Services

BBB Business Profiles may not be reproduced for sales or promotional purposes.

BBB Business Profiles are provided solely to assist you in exercising your own best judgment. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles.

When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.

BBB Business Profiles generally cover a three-year reporting period. BBB Business Profiles are subject to change at any time. If you choose to do business with this business, please let the business know that you contacted BBB for a BBB Business Profile.

As a matter of policy, BBB does not endorse any product, service or business. Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation. BBB charges a fee for BBB Accreditation. This fee supports BBB's efforts to fulfill its mission of advancing marketplace trust.

Cookies on BBB.org

Complaints

Customer Complaints Summary

If you've experienced an issue

Filter and sort by

Sort by

Complaint status

Complaint type

Complaint statuses

Business Response

Customer Answer

Complaint statuses

Business Response

Complaint statuses

Complaint statuses

Business Response

Customer Answer

Complaint statuses

Business Response

Customer Answer

Business Response

Complaint statuses

Business Response

Customer Answer

Business Response

Customer Answer

Complaint statuses

Business Response

Customer Answer

Complaint statuses

Business Response

Business Response

Customer Answer

Complaint statuses

Business Response

Complaint statuses

Business Response

Customer Answer

Business Response

UPMC Health Systems is NOT a BBB Accredited Business.