What’s going on? UPMC-Highmark deal leaves public confused

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Like that divorcing husband and wife who squabble over every household item, Highmark and UPMC inked a state-brokered separation agreement late last month and then resumed their argument over who gets what. Stuck in the middle of this acrimonious breakup are Highmark’s Western Pennsylvania subscribers.

Under the deal announced June 27 by Gov. Tom Corbett, state Attorney General Kathleen Kane and other officials, Highmark subscribers enrolled in Medicare, Medicaid and the Children’s Health Insurance Program will retain total access to UPMC facilities after the current contract between the health giants expires on Jan. 1. The remaining Highmark customers will lose in-network access to half of UPMC’s 16 hospitals, in particular those that are centrally located in Pittsburgh including Magee-Womens, Montefiore, Presbyterian and Shadyside.

The consent decrees that both parties signed also address specialty care, emergency care and continuity for Highmark subscribers who are receiving treatment from UPMC facilities and physicians, but the July 15 deadline for working out those details passed without resolution.

That wasn’t surprising given what has transpired in recent days.

Highmark ran newspaper ads that said its subscribers “will have in-network access to all UPMC services for oncology care, including the Hillman Cancer Center.” UPMC circulated a flier to employers and insurance brokers rebutting the claim.

Highmark minimizes the impact its customers will feel next year, and UPMC says Highmark exaggerates how much access they will have without paying higher, out-of-network rates.

Employers and patients who must make costly decisions about what coverage to purchase aren’t alone in asking questions. State Rep. Tony DeLuca of Penn Hills, the Democratic chair of the House Insurance Committee, sent a letter asking those questions and more to Mr. Corbett, Ms. Kane and others to clarify the meaning of the agreement.

The questions go to the core of what health insurance customers can expect from their coverage. Highmark and UPMC both are trying to sell their facilities and their insurance plans. In doing so, they are obligated to give honest and complete explanations. It is the public that will pay dearly if the choices they make are based on misleading answers and false expectations.

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