Complaints

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

close

Find a Location

UPMC Health Systems has 7 locations, listed below.

*This company may be headquartered in or have additional locations in another country. Please click on the country abbreviation in the search box below to change to a different country location.

BBB accredited

Near

Country

USUnited States

Please enter a valid location.

Filter

• 

  UPMC Health Systems

  600 Grant St Pittsburgh, PA 15219-2702

• 

  UPMC Health Systems

  2 Hot Metal St Pittsburgh, PA 15203-2348

• 

  UPMC Health Systems

  5230 Centre Ave Pittsburgh, PA 15232-1304

• 

  UPMC Health Systems

  PO Box 371980 Pittsburgh, PA 15250-7980

• 

  UPMC Health Systems

  1650 Metropolitan St Ste 300 # 3 Pittsburgh, PA 15233-2213

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:07/16/2024

  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.

  Because my complaint was ignored on the UPMC portal I have attached my complaint here.

  Business Response

  Date: 07/25/2024

  Dear
  *** ******,
  
  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

• Initial Complaint

  Date:07/08/2024

  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.

  On May 14, 2024 two checks were issued for payment on my account and my husbands. I paid through PNC Bank. Two checks were issued for $20.00 each. We each got past due notices dated 5-29-2024. I faxed proof of payment for both accounts on June 4, 2024 costing me $7.95 to do so. I have been speaking to an Angela M. at ************. When calling most of the time I get someone in a foreign country and they say 'We will leave her an e-mail" We got past due statements again dated 7-01-2024. This is the second time this has happened and I proved both times that I made payments. This costs me money because I have to pay to fax them. With copies of the checks in front of them what could be the problem. I worked at ********* **** for 43 years so I know the procedures. I think I have given them plenty of time to solve this problem and fix both of our accounts. I know $20.00 on each account isn't much but someone isn't doing their job. I would like to have this corrected because it's been almost 2 months.

  Business Response

  Date: 07/09/2024

  Dear
  *** ******,
  
  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: 08/09/2024

  After spending hours on the phone for 2 days, I was told to fax "PROOF of payment" to you.  Here is a copy of my current "Past Due" statement for $20.00.  Also is a copy of the front and bck of check used for payment.  My husband also got a past due statement for $20.00.  Also enclosed is a copy of the front and back of his check.  Three times this year I have had to go to Staples to fax proof.  I have even sent UPMC a bill for reimbursement which they never paid.  For a company as big as UPMC there is a problem when payments can't be located.  I would appreciate a phone call as acknowledgement.

• Initial Complaint

  Date:05/30/2024

  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.

  So, this is the third time now that this has happened.
  
  Incident 1 - I was given a different script for my estradiol patches which I have been using for over four years now (I am transgender and this is part of the gender affirming therapy I am on). I was allergic to the script they switched me to, this was a generic brand. I sent photographic evidence of this via the portal to the office. I asked for this to be changed to another brand. It was not. This took weeks to fulfill.
  Incident 2. Same brand was FINALLY filled after they managed to figure out a prior auth. Still allergic to it. I sent photographic evidence of this via the portal to the office. Weeks went by until it was filled again.
  Incident 3. I am now out of meds again. Which I am not supposed to be off of, as they are hormones. The office is still unable or unwilling to assist me. Their messages and communications, while sent in a timely fashion, are incredibly vague and unhelpful. I have to keep going after them for answers, which are never provided.
  
  I need to setup a conference call/Zoom with UPMC corporate and UPMC Rodney Rd, York PA. I need to get this sorted out and understand why a simple script refill is so difficult. It's a doctor's office, they write scripts all day!

  Business Response

  Date: 05/30/2024

  Dear
  Ms. Folino,
  
  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

• Initial Complaint

  Date:05/03/2024

  Type:Service or Repair 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.

  I was experiencing discomfort in my right shoulder, most likely due to a years old injury flaring up. I went to the doctor to have it checked out. I wound up seeing Dr Mark R****** UPMC sports medicine facility.
  
  I made the appt early as not to miss work, was kept waiting an hour and 5 minutes in the exam room, doctor showed up at 9:05 am, not a peep about it from him, no acknowledgment, no apology, nothing. Then he gave me a brief exam, prodded my shoulder, took x-rays, and said, "I need you to get an MRI." I said, "Dr, I saw you 10+ years ago for a bike accident related injury on my other shoulder, we tried an MRI, but I was unable to do it due to the width of my shoulders, it didn't work, we wound up going with a sonogram." No response to this. Clipboard in hand, he was already out the door, saying, "See the woman at the front desk and make an appointment with her." He was a reputable doctor, a specialist, so I hesitated, then I made the appointment, even though I didn't think it would work, I was willing to try.
  
  I showed up for the MRI, the technician put me in the machine, closed the lid, and as I predicted, it was very tight, so much so, it produced pain to where I was unable to hold still, though I tried. After a grueling and LONG 20 minutes the tech aborted the MRI, saying, " you can't move, it won't work if you move." I was in pain, as it pushed against my shoulder which was already injured. I left, furious at being put through this ordeal by a doctor who didn't listen to me.
  
  I was/am traumatized from this and was not about to pay for it, so I blew off the bills they sent. Recently a collection agency has called me saying they want the $578 I owe UPMC. I have called their customer service, no help. I have called their patient relations dept twice now, after over a month, nothing, they are not helping me at all, just giving me a run around.
  
  At this point I don't know what to do, I have excellent credit and do not want to have it destroyed over this.

  Business Response

  Date: 05/22/2024

  Dear ***** ******,
  
  This is UPMC’s response to the complaint filed
  under Better Business Bureau ID number ********. 
  
  The complainant states that an MRI performed on his
  shoulder was not completed.    
  
  The case was reviewed. 
  The charges for the MRI that was not completed have been credited to
  this individual’s account and the remaining balance has been paid. 
  
  We thank you for
  this opportunity in allowing us to review and resolve these concerns.   
  
  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

  Customer Answer

  Date: 05/29/2024

  
  

  "I spoke to a woman at UPMC who called me to discuss this matter, she was the first one to take the time and talk to me like a customer. I am grateful for that. They worked it out to my satisfaction."

  
  

• Initial Complaint

  Date:04/23/2024

  Type:Product 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.

  On January 24 2024, I **** ******* attended an appointment to see my Neurologist Dr. M*********** at the UPMC outpatient office in Lancaster, Pa. This appointment was for me to renew my Medical Marijuana license. This transaction is not insurance related. I attended the appointment and paid the amount of $150.00 for this treatment, this was paid with my Visa/Debit card. This particular card had to be closed due to a fraudulent action which ended in a major loss for me. I had no choice but to close this account and open a new one, this included my entire account. I provided my new account information and was told that the refund would have to be a check due to the account number change.
  
  My new license was not received or renewed by this provider. The ID did was not received, so this is where I started my communication with this company (UPMC).
  
  On the second week of February I began calling them in regards to not receiving my new license. The office receptionist told me that she would put a message for the office manager to look into this matter. After this there were a lot of phone communications as well as one impromptu office visit for me to talk to the office manager about the status of my issue. Since that visit there were as many as 12 phone calls from myself trying to get a refund for a service not provided. During these phone calls I spoke with 10 different employees that communicated with me and stated many different responses.
  
  My request for a refund was passed along to different departments without results. I believe it was the beginning of March when I called again and was now told that since Dr. M*********** joined UPMC he no longer participated in the Medical marijuana program. This call was made approximately four weeks of talking to all these employees.
  
  I was informed that my refund check was approved and mailed to me from their Texas office on April 4, 2024. After not receiving the check I continued my communications with no results today.

  Business Response

  Date: 05/06/2024

  Dear ***** ******:
  
  This is UPMC’s response to the complaint filed
  under Better Business Bureau ID number ********.
  
  The complainant believes that a refund from
  UPMC is due but has not yet been received. 
  
  UPMC reviewed the relevant account.  The refund was processed by check because the
  credit card on file was no longer active, so the refund could not made electronically.  The refund check was issued on April 24, 2024,
  and should be received 10-14 days from that date.   
  
  We thank you for
  this opportunity in allowing us to review and resolve this individual’s
  concerns.   
  
  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

• Initial Complaint

  Date:03/22/2024

  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 had a cosmetic procedure that I paid cash for that was not covered under my insurance. I was informed this but was already aware of this. I paid for my procedure with a cc. I was fraudulently billed to my hospitalization anyways in which I also had to pay 50.00. This should have not of been billed to my insurance as it is not a covered procedure. This needs to be stopped.

  Business Response

  Date: 04/09/2024

  Dear Ms. ******,

  This is UPMC’s response to the complaint filed under Better Business Bureau ID number ********.  The confusion here arises from the fact that the complainant received multiple services on the same day, which were billed separately.
  
  The complainant was seen for the first time in the office on January 24, 2024. The complainant was evaluated for three diagnoses.  During the appointment, it was determined that a cosmetic procedure was available for one of these diagnoses, and that the physician had time on the schedule for the procedure to be completed that same day.  The procedure was performed after discussion with the patient.  
  
  The verbal conversation with the patient concerning the cosmetic procedure and the $100 pricing was completed during the office visit.  The cosmetic procedure performed was not billed to the patient’s insurance.
  
  The office visit charge for the physician was appropriate based on the medical notes in the patient’s file and discussions of the complainant’s other diagnoses during the visit.  The office visit was billed to the complainant’s insurance at a cost of $88.00.  The complainant’s insurance allowed $53.34 of the $88 billed and assessed a $50 copayment as patient liability.  
  
  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: 04/17/2024

  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.
  
  
  
  *** ****** ** ** ******** **** ****** ** * ****** ** ***** **** ** **** **** **** ** *** ********
  
  
  
  Regards,
  
  
  
  ******* ********

• Initial Complaint

  Date:02/20/2024

  Type:Service or Repair 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.

  yes UPMC offers their member this card called the health bennifets card and every 3 months they put $ 400 on it for their members to go to certain food stores and buy healthy food like dryed foods frozen food fresh meants and things like that well one of the stores is walmart but the only problem is none of the members can buy health meats from walmart we have an app wae can down load on our phones where we can scan the bar codes to see if our card will pay for the foods and upmc says that all freah meats at walmart arer able to be tyo be paid for with our health bennifets card the onlu problem is when we scan the bar code it say not covered i have told upmc this many times i have filed so many compolaints about walmart but upmc does nothing to to make walmart fallow the rules it like my complaints fall on deff ears it been going on for a year now and i have told upmc so may times bout this and all they say is sorry do you want to file a greavance and nothimg is done about it then on 2-1524 i ordered a fresh fruit box they offer for free to it members that is to be delivedred in 2 days i called on 2-18 tosee if mimne would be delivered todasy and they said if you dont have it by the middle of nexst week callkus when it was told it would be delivered in 2 days so i ordered it on 2-15-24 it should hve been delivered 2-18-24 and it was njot they said they have no ytrascking infor for it its like they dont even care about there members not about how walmasrt is treating us or anything they expect us to pay for the meat out of our own pockests and wait 2 weeks for a remburtsmenbt check i cant affort it because im on a limited imcome i have even talked to a superviser and still nothing been done about walmart and i want my freshfruit box ekivered with fresh fruit nit spoiled fruit

   

  ADDITIONAL INFORMATION:
  
  Hello ***** I have 1 more thing to add I went and ordered another fruit box from my quaroploigic husband from UPMC and they were trying to say they couldn't send it because on their end it was saying his address was *** ****** ** was a pobox I ask them how can that be because his address is the same as mine when you sent me my fruit box because we are married and live in the same house she said well it show total I said no because we both get the health benefits card I said I will be letting the BBB know this. 

  Business Response

  Date: 03/15/2024

  UPMC Health Plan, *nc. ("UPMCHP") has rece*ved and rev*ewed your letter dated March 5, 2024, as well as the Author*zat*on to Release Health *nformat*on s*gned by ***** ********. Ms. ********'s compla*nt relates to *ssues us*ng her UPMC for L*fe Shop Healthy Card and order*ng Health and Wellness K*ts.

  Ms. ******** *s a member of UPMC for L*fe Complete Care (HMO D-SNP), a dual-el*g*ble Spec*al Needs Plan (D-SNP) offered by UPMC for You, *nc. For the 2023 and 2024 plan year, UPMC for L*fe Complete Care offered as a supplemental benef*t the UPMC for L*fe Shop Health Card, a Value-Based *nsurance Des*gn (VB*D) program. Th*s *ncludes a $400 quarterly allowance that could be spent on covered over the counter (OTC) health care products and healthy foods.2 The Shop Health Card allowance could be used for certa*n categor*es of healthy foods purchased *n-store at select part*c*pat*ng reta*lers. *n 2024, UPMC for L*fe Complete Care members who qual*f*ed for Extra Help were also able to rece*ve up to two Health and Wellness K*ts per year. Members were able to choose between several opt*ons, *nclud*ng general household and wellness k*ts, f*tness k*ts, produce k*ts, and meal k*ts, wh*ch would be sh*pped d*rectly to the member at the*r address on f*le. 
   
  Accord*ng to our records, on October 23, 2023, Ms. ******** called UPMC for L*fe Complete Care Member Serv*ces and f*led a gr*evance regard*ng the Shop Healthy Card. *n January and February 2024, Ms. ******** called UPMC for L*fe Complete Care Member Serv*ces several t*mes. She sa*d that when she scanned the bar codes of meat *tems at Walmart Supercenter *n Meadv*lle Pennsylvan*a us*ng the UPMC Health Plan app on her phone, these *tems showed as not covered. Ms. ******** stated that she was exper*enc*ng the same *ssue at G*ant Eagle *n Meadv*lle Pennsylvan*a. 
  

  On February 17, 2024, Ms. ******** f*led th*s compla*nt. From February 17 through February 20, 2024, Ms. ******** called UPMC for L*fe Complete Care Member Serv*ces several t*mes say*ng that she ordered Health and Wellness K*ts for herself and her husband but has not rece*ved the k*ts or track*ng *nformat*on of the k*ts. 

  *n response to Ms. ********' compla*nt regard*ng her UPMC for L*fe Shop Healthy Card, UPMCHP outreached to our Shop Healthy Card benef*t vendor. UPMCHP can only requ*re certa*n general categor*es of grocery *tems to be covered by Shop Healthy Card. Our Shop Healthy Card benef*t vendor contracts w*th each part*c*pat*ng reta*ler who dec*des whether each spec*f*c grocery *tem *s covered at the part*c*pat*ng reta*ler's locat*on. We are currently work*ng w*th our vendor to *nvest*gate the *ssue regard*ng the UPMC Health Plan app *dent*fy*ng el*g*ble foods at Walmart and G*ant Eagle stores. 
   
  1 2023 UPMC for L*fe Complete Care Ev*dence of Coverage, 67 (excerpts attached), 2024 UPMC for L*fe Complete Care Ev*dence of Coverage, 66 (excerpts attached) 
  2 For 2024 the allowance could also be spent on pet care suppl*es and pest control serv*ces. See 2024 UPMC for L*fe Complete Care Ev*dence of Coverage, 66. 
  3 *d. at 67. 
  3/14/2024 4:56:37 PM 
  

  As noted above, Health and Wellness K*ts are sh*pped d*rectly to members' address on f*le unless a d*fferent ma*l*ng address has been prov*ded. *n response to Ms. ********' compla*nt regard*ng sh*pp*ng her Health and Wellness K*ts, UPMCHP outreached to our Health and Wellness K*ts benef*t vendor and prov*ded our vendor w*th Ms. ******** and her husband's current address. We are currently work*ng w*th our vendor to obta*n update on Ms. ********' order. 
  

  Should you have any further quest*ons, please contact UPMC for L*fe Member Serv*ces at 1-877-539-3080. 
  

  Respectfully Subm*tted, 
  

  "Cam*lla" R******* L*, Esq. 
  Staff Attomey 
  UPMC Health Plan 
  

  
  

  Customer Answer

  Date: 03/15/2024

  ** ******* ****** ** ******** **** ***** ********* **** ********** ** *** ********** *********  ** *** ***** *** *** ****** ** ****** ******* ****
  
  
  
  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: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.