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.

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• 

  UPMC Health Systems

  600 Grant St Pittsburgh, PA 15219-2702

• 

  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

• 

  UPMC Health Systems

  200 Lothrop St Pittsburgh, PA 15213-2536

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:12/13/2022

  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.

  This complaint is related to BBB case #********, filed 12/13/2022 against ***** Insurance.
  
  There is an ongoing dispute between UPMC (my healthcare provider) and ***** (my health insurance provider) that has resulted in an unpaid bill of $281.00 for a service that was provided March 10, 2021. UPMC has now referred this bill to a collection agency to come after me.
  
  I have been on multiple phone calls with ***** and with UPMC, including some 3-way calls with both parties, in an effort to get this resolved. I blame the bureaucracy of both companies for this impasse. WHEN 2 CORPORATE HEALTHCARE GIANTS DISAGREE OVER A BILLING MATTER, CERTAINLY THEY HAVE A PROCEDURE FOR RESOLVING IT THAT DOES NOT INVOLVE TAKING IT OUT ON THEIR CUSTOMERS? But apparently not.
  
  Some background:
  ******* 4/15/2021 Explanation of Benefits regarding the disputed bill states: "We have denied all or part of this claim. However, you are not responsible for paying the billed amount because you received this service from an ***** Medicare plan (PPO) provider OR based on a referral from an ***** Medicare Plan (PPO) provider."
  
  Based on this determination, I have not paid UPMC's $281 bill for this service. Regardless, UPMC has continued to send me bills. Recently ***** has indicated to me that they would pay this bill. I relayed that information to UPMC by phone in September 2022. Nonetheless, UPMC has now referred the bill to a collection agency.
  
  One of two things is true: EITHER UPMC wrongly billed me in the first place. OR ***** is responsible for paying this bill. I am not responsible for mistakes made by EITHER of these companies and I request that UPMC communicate and resolve this matter with ***** and withdraw its referral to a collection agency.

  Business Response

  Date: 12/19/2022

  *** ****** **********************
  December 19, 2022
  Ref:  *** ID #: ********
  

  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.

  The patient was incorrectly billed for an out-of-pocket
  amount.   This was UPMC’s error.   The account has been corrected, the balance
  adjusted to zero, and the patient has been contacted by telephone with the
  results of this review. 

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

  
  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

• Initial Complaint

  Date:12/12/2022

  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.

  I went to the ***** ********** in Harrisburg, PA, to talk to a doctor about weight gain and asked for a blood test for testosterone because my father has low T and I wanted to get that specifically checked to see if it was hereditary. I was sent to get blood testing done and found out that T had not been checked but I was still billed anyway. I contacted billing and was told that the bill would be contested. I called and left a message for the office manager and nobody reached out to me to discuss the issue with me. I was not told about the outcome. I called again and was given equally unhelpful answers and was told that the Nurse Practitioner had decided that the results of the test were important. I disagree citing our conversation about specifically Testosterone. I no longer want to deal with UPMC and would like to find another health care professional but would like my money back because I was fraudulently charged for services I did not consent to.

  Business Response

  Date: 12/27/2022

  In response to Mr. ******** complaint of his office visit at ***** ********** on August *, 2022 and subsequent
  laboratory work on August *, 2022, we have found the following.
  
  During Mr. ******'s new patient
  visit to establish a new primary care, Marija K*********, CRNP, discussed and
  ordered the laboratory work based on the information Mr. ****** provided during
  that new patient visit.  Mr. ******
  received a copy of his laboratory order and an after visit summary when he
  checked out from his appointment.    
  
  Mr. ****** had
  his laboratory work completed on August *, 2022.  At that time Mr. ******
  also signed the UPMC Consent for Treatment, Payment and Health Care Operations
  (TPO) in Pennsylvania, attached.  The total charge for his laboratory work
  was $2*6.00 and was submitted to his Blue Cross Blue Shield insurance. 
  Mr. ******'s insurance processed the services and applied $159.77 to his
  deductible.  Deductibles, coinsurance and co-pays are a patient's
  responsibility and are billable to the patient. 
  
  Mr. ******'s
  complaint also states he contacted UPMC in Central Pa Customer Service (billing)
  which he did twice on October 31, 2022.  The first representative that he
  spoke with advised Mr. ****** he would need to contact the office to discuss
  the clinical reason the laboratory tests were ordered.  He again stated he
  didn't know why the tests were ordered and as the representative started to
  explain, he hung up on the representative.  Mr. ****** also utilized
  messaging through the UPMC Central PA portal on October 31, 2022, to which
  he was in contact with Marija K*********, CRNP.  She explained the clinical reasons why each test was ordered. 
  During this time of messaging, Marija K*********, CRNP, did include an order
  for the testosterone testing Mr. ****** requested.  Mr. ****** called customer service a second
  time on October 31, 2022, and the representative that he spoke with
  advised Mr. ****** another request would be sent to the office manager for
  review, because Mr. ****** feels he shouldn't have to pay for the tests
  completed on August 9, 2022, since the testosterone test was not on the order,
  and he would have to make another appointment.  
  
  On November 7,
  2022, Mr. ****** contacted customer service to follow up on his account from
  the October 31, 2022, phone call.  Mr. ****** wanted the representative
  that he spoke with to mark his concern as high importance and shared he needs
  to get another test done and he wants to be refunded the money he paid for his
  laboratory work performed on August 9, 2022.  He stated he feels he
  shouldn't have had to pay for the tests on August 9, 2022, since it did not
  include the testosterone test. 
  
  A review was completed
  by the office manager on November 25, 2022, and stated the laboratory work was
  necessary based on the clinical reason for his visit on August *, 2022. Mr.
  ****** is correct, the customer service representative did not contact him with
  the results of the review from the provider's office.  Due to the
  representative not responding timely, this prompted Mr. ****** to call back
  into customer service on December **, 2022.  The customer service
  representative he spoke to advised him of the outcome of the review from the
  office manager.  Mr. ****** was not satisfied with the outcome and stated
  he was going to contact the office manager.  
  
  Mr. ******
  called the office manager on December **, 2022, and the office manager
  explained again why the tests were ordered.  The office manager had Marija
  K*********, CRNP call the patient back on December 13, 2022.  Marija
  K*********, CRNP discussed with Mr. ****** his August *, 2022, visit and his
  laboratory orders.  The provider also advised Mr. ****** he may go to any
  lab his insurance approves to have blood drawn.  At that time the patient
  advised the provider he does not trust UPMC and is not coming back because it
  is very expensive.     
  
  No refund will
  be forthcoming for the laboratory services completed August *, 2022, as Mr. ******'s laboratory work was ordered based on the concerns he
  presented during his new patient visit on August *, 2022.  We will
  however, waive the patient responsibility assigned to Mr. ****** if he chooses
  to have the testosterone completed at a UPMC Central Pa location, to which is
  billed by UPMC Central Pa.  Mr. ******
  may contact UPMC Central Pa Customer Service at ###-###-#### once he receives
  the bill for the testosterone and request to speak to a team lead who will
  adjust the patient portion as applied by his insurance. 
  We hope the
  information provided resolves Mr. ******’s concerns.  

  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

• Initial Complaint

  Date:12/09/2022

  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 have been on ******* to treat my MS for years. The drug company covers the cost of my medication. UPMC has made a deal with Pfizer to switch all ******* patients to ******** which will cause patients to incur significant costs.

  Business Response

  Date: 12/13/2022

  Dear Ms. *****,

  Please note Ms. ****** did not enter nor sign a HIPAA release form for our organization to properly address her concerns; therefore, we cannot proceed with our review at this time. We ask that Ms. ****** provides her signature on HIPAA release form and return to us so we may begin our review of this complaint.

  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

• Initial Complaint

  Date:11/08/2022

  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.

  UPMC community health choices ************ ,is my insurance carrier who subcontracted a company named ******* ****** *** located at *** ****** ******* *************** ***** **** ***.to install a poured concrete handicap walkway on 10/07/2022.The workers had no work order or contract to work from. In addition no one spoke English. They mixed concrete from bags on my lawn.It was not poured from a truck as my work order indicated. They had no idea what work was to be completed. I gave the workers a case of water, soda and lunch then they threw their trash on my lawn and my neighbors yard. I’n addition they urineated on my lawn and bushes. My neighbors were irate and UPMC would not return my calls or address this issue.Upon completion they left my walkway lights in a pile , cut the wires in 3 places and left them inoperable. I made several attempts to ask UPMC for help but my calls to UPMC fell on def ears.(photos and security video furnished upon request) The men urinated on my bushes and lawn. They left live electric wires sticking out of the ground and my walkway lights inoperable.This was days before Halloween when the children could get hurt. Still UPMC has not addressed my concerns and damaged my property.They would not let me file and sit in on my greavance. DHS and the PA insurance commission have been notified.

  Business Response

  Date: 11/29/2022

  Hello,

  We are in receipt of the complaint. At this time, we have forwarded the complaint to the UPMC Health Plan for further handling.

  We appreciate the opportunity to respond this complaint.

  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

  Customer Answer

  Date: 11/30/2022

  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.
  
  
  
  *** ****** ** ** ******** **** ****** ** * ****** ** ***** **** ** **** **** **** ** *** ********
  ******* ****** hired by UPMC to install a safe walkway in my home. They cut walkway wires and broke walkway lights. The contract states to replace and install lights.Hazardous conditions exist.
  
  
  ******* *******

  Business Response

  Date: 12/01/2022

  Complaint ID # ******** 
  

  **** *** ****** 
  

  UPMC Health Plan, Inc. (“UPMCHP") has received and reviewed your letter dated November 23, 2022 as well as the accompanying complaint. 
  

  The above-referenced complaint did not include a HIPAA authorization that would allow UPMCHP to disclose protected health information. Without a HIPAA-compliant authorization, UPMCHP is unable to provide a response to the Better Business Bureau regarding this complaint. However, UPMCHP will determine whether the affected individual is a UPMCHP member and, if so, will respond directly or otherwise outreach to the affected individual with a more detailed response. 
  

  Should you have any further questions, please contact me at ************* 
  
  

  Respectfully Submitted, 
  
  

  Steven A. V***** ****

  Staff Attorney 

  UPMC Health Plan

  Business Response

  Date: 12/07/2022

  Hello,

  We are in receipt of the complaint. At this time, we have forwarded the complaint to the UPMC Health Plan for further handling.
  

  We appreciate the opportunity to respond this complaint.
  

  Sincerely,

  UPMC Office of Ethics, Compliance and Audit Services

  Customer Answer

  Date: 12/09/2022

  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.
  
  Waiting on merchant to respond to complaint.
  
  *
  
  Regards,
  
  
  
  ******* *******

  Customer Answer

  Date: 01/05/2023

  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 HIPA form was signed, faxed and mailed on 12/1/2022 .I contacted UPMC 3 times regarding this matter.(copy enclosed)The information UPMC is providing is incorrect.
  
  
  
  Regards,
  
  
  ******* *******

  Customer Answer

  Date: 01/05/2023

  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.
  
  
  Nothing has been done by UPMC or ******* ****** contractor to repair or resolve this issue. Hazards conditions exist due to the work ******* ****** contractor preformed . DHS and PA insurance commissioner have been notified.
  
  
  
  Regards,
  
  
  
  ******* ******** 

  Business Response

  Date: 05/10/2023

  UPMC Community Health Choices, Inc. (“UPMC CHC") is in receipt of your letter dated January 12, 2023 and accompanying message from ******* *******. As we believe this situation now to be resolved, we can offer the following response. 
  
  UPMC CHC received the first complaint from Mr. ******* regarding this issue on October 7, 2022. This complaint was conveyed over the phone to a UPMC CHC Member Services Representative. An acknowledgement was sent to Mr. ******* dated October 10, 2022. On October 15, 2022, UPMC CHC Complaints & Grievances received a fax from the member.1 This contained, among other things, a copy of an invoice from a company named ******** ******** dated October 12, 2022, which Mr. ******* indicated was for the repair of his broken lights due to the home modification by ******* ******. This invoice listed $260.00 as the amount owed. On the bottom, next to Mr. ********s signature, was written "$260.00 paid cash." 
  
  UPMC CHC has reimbursed Mr. ******* for $260, the amount listed on the invoice that was submitted to us on October 15, 2022. This amount serves as reimbursement in resolution of this issue. The check was dated March 2, 2023, and we have received confirmation that Mr. ******* received and cashed it. Additionally, UPMC CHC will continue to ensure that all work tasks related to benefits provided under the plan are performed professionally and completed per written work orders. As such, we believe this matter to now be closed.
  
  Should you have any further questions, please contact me at ************. 
  
  Respectfully Submitted,
  
  Steven A. V****, Esq. Staff Attomey UPMC Health Plan 

  Customer Answer

  Date: 05/11/2023

  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 be advised that UPMC paid $260 for electricians labor . However the materials to repair and replace damaged light fixtures has not been paid. (Receipts enclosed $122.00)In addition I would like the 5 year warranty in writing as promised by representative from ******* ****** and UPMC.Warranty is not on my work order.
  
  Regards,
  
  
  
  ******* *******

• Initial Complaint

  Date:10/24/2022

  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 9/2/2022, I received an invoice for the first time for services allegedly rendered by UPMC Home Healthcare in February 2016. The invoice was for 3 copay amounts totaling $33.06. These services were allegedly rendered on 2/5/2016, 2/8/2016, and 2/10/2016. This was the first invoice I ever received from UPMC Home Healthcare for this copay amount.
  On 9/16/2022, I received the invoice again. I called the UPMC Home Healthcare business office (###-###-####) for an explanation. I was told that UPMC Home Healthcare was just "catching-up" on their billing and apologized for the 6 1/2-year delay in billing the $33.06 copay. I asked for some documentation that services were ever rendered. She said that she would look into the matter.
  On 10/12/2022, I received the invoice for the third time, and I called the UPMC Home Healthcare business office (###-###-####) again for an explanation. At 10:45 AM on 10/12/2022, I spoke with Kristin on a recorded line and disputed the charges. She agreed that this matter was "ridiculous" and recorded my dispute.
  On 10/24/2022, I received the invoice for the fourth time marked as "past due notice" and demanding payment of $33.06 within 5 days.

  Business Response

  Date: 11/07/2022

  Ref: ***** *****, File ID ********
  
  Dear **. *****:
  
  We have received the complaint filed with your office on October 25, 2022, by **. ***** *****, our patient, due to concerns with billing. All due diligence was done to ensure **. ******* account balance is now zero for the bills he referenced in his complaint.
  
  Thank you for the opportunity to respond to this complaint.
  
  Sincerely,
  
  UPMC Office of Ethics, Compliance and Audit Services

  Customer Answer

  Date: 11/08/2022

  ****** ******** *******
  
  
  
  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:10/18/2022

  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 called and cancelled my insurance with upmc on August 5th to which the upmc representative agreed to. Since then, I have received 2 more bills claiming my payments needed to be made or my insurance would be cancelled. This action by them falsely sets me up to have not paid a bill to which they can report to a collection's agency and report to credit bureaus. I'm sure this is happening to others and needs to stop.

  Business Response

  Date: 10/27/2022

  **** *** ****** 
  

  UPMC Health Plan, Inc. (UPMCHP) has received and reviewed your letter dated October 18, 2022, as well as the Authorization to Release Health Information signed by Mr. ****. Please accept the following as the response of UPMCHP to the concerns expressed by Mr. **** regarding the above-referenced complaint. 
  

  For the 2022 plan year, Mr. **** enrolled in a UPMC ********* **** exclusive provider organization plan that he purchased directly from UPMCHP. According to Mr. ****'s Policy, members who purchase their coverage directly from UPMCHP are permitted to terminate their coverage by providing UPMCHP with either written or verbal notice of their intent to do so. Regarding when such a request for termination takes effect, Mr. ****'s Policy provides: 
  

  When to Provide Notice: You must provide UPMCHP with this notice by the 1st business day of the month immediately following the month in which you wish to terminate your coverage under this Policy. For example, if you wish to terminate your coverage effective March 31st, you must notify UPMCHP no later than April 1st

  Retroactive Termination: In the event that you obtain coverage under a different UPMCHP policy or through another carrier, UPMCHP may honor your request to retroactively terminate your coverage under this Policy, if such termination would not result in the reversal of claims. You must provide UPMCHP with written or verbal notice within 30 calendar days of your requested retroactive termination date. For example, if you wish to terminate your coverage effective March 31st, you must notify UPMCHP no later than April 30th (Policy, p. 42). 
  

  Mr. **** called UPMCHP on September 12, 2022, wanting to terminate his coverage with us retroactively to August 31, 2022. Our Member Services department informed him that because he has no outstanding claims for the month of September, UPMCHP is able to retroactively terminate Mr. ****'s plan to August 31, 2022. Unfortunately, our Member Services never informed Mr. **** that he would need to provide proof of new coverage prior to the retroactive termination. Mr. **** mentions in his complaint that he called UPMCHP on August 5, 2022, to cancel his coverage, however UPMCHP does not have any records of such a call being made. 
  

  On September 12, 2022, and September 16, 2022, UPMCHP Enrollment Team attempted to reach Mr. **** to inform him that he needed to provide UPMCHP with proof of new insurance prior to the retroactive termination being implemented. A call back number was provided each time. Our records indicate that Mr. **** never called UPMCHP and never provided UPMCHP with proof of new insurance. 
  

  However, due to the information provided to Mr. **** on the September 12 call with Member Services, UPMCHP will make a one-time exception and terminate Mr. ****'s coverage effective August 31, 2022. He will not be obligated to pay his premium for the months of September and October. A termination letter will be sent to Mr. ****. Additionally, UPMCHP will also provide coaching to the Member Services representative that spoke with Mr. **** on this September 12 call. 
  
  UPMCHP apologizes for any inconvenience this may have caused Mr. **** and thanks him for bringing this to our attention. 
  

  Should Mr. **** have any additional questions, he may contact our Member Services department at the telephone number on his Member Identification Card. 
  

  Respectfully Submitted, 
  

  
  Praneeta G. S*******, Esq. 
  Staff Attorney 
  UPMC Health Plan