Highmark swells insurance plan's reach

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Highmark Inc., like any bestriding world colossus, is finding that big wars are fought in multiple theaters.

Here in the southwestern theater, Highmark is dueling with UPMC for both insurance customers and -- now that Highmark has its own health network -- hospital patients.

But on the faraway Central front, Highmark is actively skirmishing with another of the state's major health care players, Geisinger Health System. Geisinger, like Highmark and UPMC, operates both a hospital network and an insurance arm.

On Friday, Highmark widened that front by pushing its new, tiered insurance plan -- which assigns Geisinger hospitals to a more expensive, less preferred tier -- into broader distribution, come Jan. 1.

In July, the Pittsburgh insurer began offering benefits through its tiered, select-network plan -- called Community Blue Premier Flex -- in nine counties in the north central part of the state. This January, the plan will be available in 21 counties: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York.

Highmark claims corporate customers that sign up for Community Blue Premier Flex can save up to 20 percent on medical bills. Patients covered by the plan who use Geisinger hospitals and their doctors will pay higher out-of-pocket costs.

In addition to Geisinger, Carlisle Regional Medical Center, Berwick Hospital Center and Easton Hospitals are assigned to the more expensive tier. Geisinger is the biggest of the bunch, though, with six general acute care hospitals and more than 1,000 beds combined, as well as several smaller rehab and outpatient hospitals, serving the midstate and Pennsylvania's northern counties.

As in Pittsburgh, the budding midstate rivalry is turning political and is playing out in the media.

In newspaper advertisements that have been running since April, Geisinger president and CEO Glenn Steele writes to his "friends and neighbors" that Highmark's split-level benefits plan is "inappropriate, inconvenient, insensitive and simply wrong [in that it] forces our neighbors to leave home to seek the care they desperately need. ... It's bad for you and your family. And it's bad for central Pennsylvania."

Earlier this year, Geisinger's chief financial officer told the Danville, Pa., Daily Item that Highmark used its financial might to bully smaller hospitals into accepting lower reimbursement rates, leaving Geisinger as the "higher cost" option.

"Many of these small hospitals really don't have the size of network and coordinating capabilities we have, and frankly don't have the ability to ever object strongly to any contract offering that someone with Highmark with all their clout makes. We think they really take advantage of those facilities," Kevin Brennan said.

In a statement, Highmark's Steven Nelson -- senior vice president of product, marketing and strategy -- said, "We are pleased with the customer response and are excited about the rollout for the entire region."

About 8 percent of Geisinger's patient load comes from Highmark commercial products, meaning the two organizations don't intersect all that much. Still, 8 percent is 8 percent, and Geisinger doesn't want to lose it.

"We've had some customers adopt the [Community Blue] plan," said Jens Thorsen, president of employee benefits and financial services at The Hartman Group, a State College benefits broker. "And we've had a lot of customers look at it and choose not to, at this point."

As a broker, he said he welcomes any product that provides extra choices and price points for businesses and customers, but he would also urge any business to look at the "pros and cons to these more narrow network" health plans.

Mr. Thorsen noted that Geisinger, for all of its protesting, does something similar with its own health insurance plan, excluding certain providers -- notably Penn State's Hershey Medical Center -- from its roster of "in-network" facilities.


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


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