Area hospitals acknowledged this week they will continue to accept both of the region’s top health plans following the recent agreement between Highmark and UPMC.
The pact between the two health care insurers was announced in Harrisburg June 27 by Gov. Tom Corbett in a deal brokered by Corbett and Attorney General Kathleen Kane.
A contract between the two companies ends Jan. 1. As a result, most Highmark subscribers will lose in-network access to UPMC doctors and hospitals after Dec. 31, meaning they will pay higher rates. Highmark said June 27 that a small fraction of its 3.2 million insurance subscribers in Western Pennsylvania will be affected.
Under the agreement, doctors can keep patients who are in the midst of a course of treatment in network at UPMC for as long as necessary. That includes times when the doctor believes the patient needs cancer treatment or a particular service that is not available from another source.
Other Highmark enrollees will be able to keep their doctors for a year if they cannot find an alternative without being billed extra.
In particular, people undergoing treatment, needing access to unique services or in an area with relatively little health care competition would fall into protected categories.
People who are 65 or older, or are covered by Medicare, Medicaid or the state’s Children’s Health Insurance Program will not be affected.
Two of UPMC’s specialty hospitals, Children’s Hospital and Western Psychiatric Institute and Clinic, will remain in-network to Highmark subscribers because they are the only institutions of their kind in the Greater Pittsburgh area.
The agreement, however, does not include Magee-Womens Hospital, Pittsburgh’s preeminent center for obstetrical services and gynecologic care.
Hospitals outside the greater Pittsburgh area – UPMC-Bedford, UPMC-Venango, UPMC-Hamot in Erie and Altoona – will remain in-network. Emergency and trauma services will continue to be accessible at in-network rates even at UPMC’s metropolitan Pittsburgh hospitals, although the companies have not negotiated an agreement on that subject yet.
Area hospitals said they continue to accept both insurance plans.
“We accept Highmark, UPMC and a plethora of others,” said Larry Pantuso, vice president of planning and development at Washington Hospital, explaining most independent hospitals accept health insurance from a variety of issuers.
Uniontown Hospital said in a news release Monday it will continue to serve the medical needs of the community, regardless of their affiliations with either Highmark or UPMC.
“Our patients have been and will continue to be our priority and our focus,” Uniontown Hospital Chief Executive Officer Steve Handy said, adding that the hospital “will continue to foster our relationships with UPMC and Highmark and keep our patients and their health at the forefront of all of our plans moving forward.”
The agreement also stipulates that UPMC Cancer Centers, like the one operated at Uniontown Hospital, will remain open to Highmark patients, provided the insurance carrier approves treatments.
“We accept insurance from UPMC and Highmark as well as all the major networks and their predominant plans,” said Mon Valley Hospital spokeswoman Mary C. Kaufman in an e-mail.
“As always, Southwest Regional Medical Center will continue to accept UPMC and Highmark insurance plans,” wrote Cindy Cowie, chief executive officer of Southwest Regional Medical Center in Waynesburg. “Prior to the agreement between Highmark and UPMC we did have concern about whether or not Highmark would cover our ER physicians, who are UPMC board-certified physicians. We were very pleased when Highmark notified us that under the terms of this agreement, emergency services will continue to be covered for our Highmark insured patients. Therefore, there will be no disruption in care or coverage for any of our patients.”
Some details remain under negotiation, but state officials stressed the deal would ensure that crucial health care decisions remain in the hands of doctors and patients after the inevitable split.
Kane called the settlement a “first step in a long process to ensure health care security in Western Pennsylvania” that averted a lengthy court battle.
UPMC is Western Pennsylvania’s dominant network, with 22 hospitals and 400 outpatient sites. However, it complained Highmark is now a competitor, since the insurer recently acquired seven area hospitals from Erie to Pittsburgh called the Allegheny Health Network, which includes Canonsburg Hospital, and it refused to extend the insurance contract with Highmark.
Allegheny Health Network spokesman Dan Laurent said Canonsburg accepts all health insurance plans with the exception of UPMC’s because the insurer “never entered contract talks with (West Penn Allegheny Health System).”
Corbett’s administration had not pressed the two companies to extend their contract, insisting instead that the split not force any patient in the midst of treatment to find a new doctor or force anyone to travel farther for hospital care.
Still, some lawmakers, consumer groups and labor unions had raised public pressure on UPMC to renew a contract with Highmark, and warned of the impact on people who will need to find a new doctor.