UPMC, Highmark reach pact

From Mirror staff and wire reports

A deal brokered by state officials will allow Highmark insurance carriers to remain in-network at some UPMC facilities, including at local hospitals UPMC Altoona and Bedford.

But some have said the deal has only made the situation more confusing for patients, with some health care providers wondering why they only solved problems for some.

The two health care giants have been at war for months, when insurance provider Highmark created its own health care network to compete with UPMC – by far the region’s largest hospital group.

The purchase took place in the midst of negotiations for a contract set to expire Jan. 1, and UPMC reacted by refusing to renew it, a move Highmark said was discriminatory because the company should provide access to any willing insurers.

Now, with the agreement, most Highmark subscribers will lose in-network access to UPMC doctors and hospitals next year, but several hospitals outside the greater Pittsburgh area – UPMC Altoona, Bedford, Venango and Hamot in Erie – will remain in-network and avoid higher costs.

Local union representatives said the agreement has confused some patients who want to maintain full access without exception and are worried what will happen if they require treatment outside the area.

“The nurses and I have been concerned about this for over a year. We send a lot of patients to Pittsburgh for tertiary care,” said Paula Stellabotte, a registered nurse and local SEIU chapter president. “If we entered into this business relationship to provide expanded services to the citizens of Blair County, it’s not right they should pay more at any other UPMC facility.”

Those patients’ coverage in Pittsburgh might differ and the costs might be substantially higher, she said.

The agreement also retains UPMC specialty facilities Children’s Hospital and Western Psychiatric Institute and Clinic at in-network rates, as well as emergency and trauma services.

So-called “vulnerable populations” also won’t be affected. This group includes people who are 65 or older, those covered by Medicare or Medicaid or who are enrolled in the state’s Children’s Health Insurance Program.

Under the agreement, doctors also can keep patients currently being treated at in-network rates “for as long as necessary,” including for cancer treatment and mental health, as well as other services that are not available elsewhere.

Other Highmark enrollees will be able to keep their doctors through 2015 if they cannot find an alternative without being billed extra.

A Highmark spokesman said Friday that only a small fraction of its 3.2 million insurance subscribers in western Pennsylvania will be affected, as only 2 to 10 percent of its enrollees had used a UPMC doctor or facility within the last year.

With some of the protections in the agreement, that number will be lower, a spokesman said.

Still, Gov. Tom Corbett – who worked with Attorney General Kathleen Kane and a team of state health and insurance officials to address patients’ and policyholders’ concerns – said the agreement was a victory for patients and consumers.

“We listened to all parties, and through a shared commitment to protecting patients and insurance consumers, designed the framework for a transition plan that focuses on putting them first,” Corbett said in a press release.

UPMC and Highmark are each set to contribute $2 million to the state to use for outreach and education during the transition, and to cover state agencies’ costs in reaching these agreements.

UPMC spokesman Paul Wood said in a news release Friday the hospital was grateful to have been able to work with Corbett, Kane and other officials to end the dispute and achieve the “shared goal of ensuring a smooth transition that’s in the best interest of consumers.”