Highmark expands Community Blue to central, eastern Pa.

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Highmark Inc. is taking its new Community Blue health insurance product out east.

Community Blue, which is available to group buyers, is a "tiered" product. That means certain hospitals and providers are in a preferred tier while others are in a "standard" tier and thus more expensive for the patient to use.

Similar to the setup in the Pittsburgh region -- where No. 1 health system UPMC is left out of the preferred tier -- the eastern version of the product puts the midstate's biggest hospital network, Geisinger Health System, in the standard, less-preferred tier.

Highmark says employers in the middle and northeast of Pennsylvania that choose the Community Blue product could see savings of up to 20 percent, because the design of the product directs patients to less expensive hospitals.

The plan will be available to customers in Centre, Columbia, Juniata, Mifflin, Montour, Northumberland, Schuylkill, Snyder and Union counties beginning on July 1. In that region, the product will be known as Community Blue Premier Flex.

"The number one question from businesses is how can we lower our health care costs; this kind of product helps give them cost savings choices," Steven Nelson, Highmark senior vice president of product, marketing and strategy, said in a statement.

Hospitals from the region that are to be included in the preferred tier are Evangelical Community Hospital, Health South Rehabilitation Center, Lewistown Hospital, Mount Nittany Medical Center, Schuylkill Medical Center, St. Luke's Miners Memorial Hospital and Sunbury Community Hospital.

Geisinger, based in Montour County, and Berwick Hospital Center, in Columbia County, are in the standard tier. Geisinger, responding to the details of the Highmark product, said that open access breeds more robust provider competition.

"Customers benefit when there are more choices made available. Competition breeds better service, more individualized options and viable rates," said Geisinger spokesman Mike Ferlazzo.

"It's unfortunate that this new plan restricts people from receiving care from Geisinger physicians and the quality they bring to the community."

Geisinger has six general acute care hospitals with nearly more than 1,000 beds combined, and several smaller rehab and outpatient hospitals, serving the midstate and Pennsylvania's northern tier. Geisinger, like UPMC, also operates its own health insurance company.

In Pittsburgh, the Community Blue product has been in the spotlight because its enrollees are at the center of an ongoing feud between Highmark and UPMC. Though UPMC's facilities aren't in the preferred tier in the local version of the Community Blue plan, Highmark says enrollees should still be able to use UPMC on an out-of-network or cash basis, if they so choose.

But UPMC says it won't see those patients, even if they want to pay cash, and on March 2 the health network gave walking papers to Community Blue customers who were patients at UPMC facilities, essentially "firing" them from UPMC practices.

Has Highmark taken measures to make sure the same thing won't happen to Community Blue Premier Flex customers?

"UPMC denying Community Blue patients is unprecedented, so we would never be under the assumption that another hospital would take that kind of action," said Highmark spokeswoman Kristin Ash.

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


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