UPMC, Highmark clarify agreement

Gov. Tom Corbett and other top state officials have brokered an updated agreement between the warring health giants UPMC and Highmark Health, sources confirmed to the Pittsburgh Post-Gazette on Tuesday night.

These sources emphasized that the agreement did not represent an extension of the contract between UPMC and Highmark, but was a separate accord negotiated over the past weeks in private sessions.

Full details of the agreement could not be confirmed at press time, but multiple sources said the term sheet included new or clarified provisions for emergency care, cancer care, continuing care for serious illnesses, and continued access for Highmark’‍s commercial customers to some doctors presently affiliated with UPMC, primarily those physicians with ties to independent hospitals.

This agreement will not permit Highmark patients to visit the primary UPMC acute care hospitals such as UPMC Mercy, UPMC Shadyside, UPMC Presbyterian, and others at in-network rates, as they currently are able to do.

Fuller details about how those Highmark patients can access these UPMC hospitals, at prescribed out-of-network rates, should emerge this week.

UPMC has insisted for years that it won‘‍t sign a new, systemwide access contract with Highmark because Highmark now operates its own hospital system, the Allegheny Health Network. Highmark, UPMC says, would advertise UPMC access in its doctor network, but in reality would steer Highmark customers to its own hospitals.  

Neither the governor’‍s office nor the office of the attorney general, which was prepared to file a legal complaint against UPMC in the event that negotiations weren’‍t fruitful, would comment on the agreement.

Representatives from the offices Insurance Commissioner Michael Consedine, Department of Health Secretary Michael Wolf, and Attorney General Kathleen Kane have been mediating sessions between Highmark and UPMC executives throughout the month. 

Those officials — dubbed the state’‍s “Patients First” leadership team — have been seeking resolution to many of the questions that remain as UPMC and Highmark head toward an apparent divorce. 

Highmark is the region’‍s dominant commercial insurer, and UPMC its largest hospital system. For years, they have prospered together, but as of now, the reimbursement contract between the two organizations is set to expire Dec. 31, meaning Highmark customers won‘‍t have full UPMC access. 

If the contract expires, only Aetna, UnitedHealth and Cigna — national, for-profit health insurers — will have full access to UPMC, Allegheny Health Network and the rest of the region’‍s major hospitals. 

Bill Toland: btoland@post-gazette.com or 412-263-2625.

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