Highmark Inc. and UPMC at odds over limited-network plan

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Highmark Inc. and UPMC are at odds over Highmark's recently unveiled "Community Blue" product, a lower-cost, limited-network health plan that excludes most UPMC hospitals from its network.

UPMC, in an online Q&A sheet about the new product, says "Community Blue patients will not be accepted by [UPMC] hospitals, facilities or physicians," except for those facilities already built into the Community Blue network.

Those facilities are Children's Hospital, UPMC Northwest, UPMC Bedford, and Western Psychiatric Institute and Clinic.

Highmark says Community Blue subscribers should be able to use UPMC hospitals so long as they choose to pay out-of-pocket, out-of-network costs: "Highmark is appalled that UPMC plans to deny access to Community Blue subscribers who are willingly choosing to pay higher out-of-pocket costs to see a provider," the company said in a statement.

A UPMC spokesman said that "Highmark designed Community Blue to compete with UPMC by offering a network that specifically excludes almost all of UPMC. ... Consumers [should] choose their health insurance carefully."

Highmark introduced its Community Blue plan last month, saying it could offer buyers premium discounts of up to 25 percent compared to plans that have full access to UPMC's hospitals and doctors.

The plan, which will begin offering benefits Jan. 1, is the first Highmark narrow-network plan since its old Community Blue plan was scrapped in 2003.

state - businessnews - health

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


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