Highmark filed its post-UPMC transition plan last Thursday with the Pennsylvania Insurance Department, but it likely will be another week — at least — before the public knows the details.
Insurance officials said Monday they intend to give the plan “a thorough internal review” before posting it.
“Consumers have made it very clear that they want concrete, understandable information,” said spokeswoman Rosanne Placey, “so we want to be sure the plan offers that.”
The plan is expected to add important detail to the consent decrees signed by Highmark and UPMC on June 27, but the wait — however wise that approach may be — is ramping up stress levels for employers, say local major insurance broker executives.
“In a perfect world, this would have been resolved a year ago,” said Shari Herrle, vice president and director of compliance for the Pittsburgh-based Henderson Brothers, Downtown, whose clients cross all business sectors.
“Companies look for certainty and stability,” said Karen Primm, senior vice president and benefits consultant with Willis Human Capital Practice, Downtown, which primarily serves mid-market companies with 250 or more employees. “A lot of us would like to see more clarity in how this is all going to work for the patient.”
So far, that clarity has largely been evasive.
Under the consent decrees, for example, officials said Highmark members still will be treated at in-network rates for cancer care and emergency and trauma care, and there are provisions for Highmark members to continue seeing their UPMC physicians at least for a year.
But it quickly became evident that this was coverage that came with asterisks:
For in-network cancer care at UPMC, the patient’s physician has to deem it necessary; the emergency care for Highmark members at UPMC hospitals lasts only until they are stabilized (the same goes for UPMC Health Plan members treated at Highmark Health’s Allegheny Health Network facilities); and the one-year “safety net” coupon is good only if the subscriber “is unable to find alternative physicians and services in their area.”
While Highmark ran ads heralding the continued access for its members, UPMC officials said they believe Highmark will use the qualifiers to steer patients to its own hospitals.
All this has left employers wondering how to proceed, and looking to brokers for help.
“We want to make sure that whatever information we provide our clients is very factual,” said Mrs. Herrle. “It is a priority for us to understand the facts and be able to communicate those facts to our clients.”
Accomplishing that “has been very challenging,” she acknowledged. “They just want to understand the implications. How is it going to affect their employees? If they need certain services, will they be available to them?”
Those are key questions that still need answers, and now is the time employers traditionally would be finalizing their insurance offerings for the coming year.
“Not every employer is in a position of being able to wait until they understand all the details,” said Mrs. Herrle.
Mrs. Primm said their Willis clients have been divided when deciding how to proceed.
Those who’ve found their providers are in Highmark’s Community Blue network are sticking with Highmark, while those who see access to hospitals such as UPMC Presbyterian and Magee-Womens Hospital of UPMC as imperative are moving toward one of the alternative insurers. Still others lean toward offering a variety of plans so employees can choose.
“You can’t look at it strictly from a financial perspective. Is it a good fit for your employees?” Mrs. Primm said.
She said employers “want decisions to be made that will be sustaining” without having to revisit the issue anew every year, but both she and Mrs. Herrle did not sound optimistic that will happen.
“Even if in two months we have a better handle on the facts, could there still be an awful lot of gray?” Mrs. Herrle asked. “And when does that become black and white?”
Steve Twedt: firstname.lastname@example.org or 412-263-1963.