Highmark vs. UPMC leaves subscribers puzzled
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One of the UPMC ads currently getting air time notes that "UPMC and Highmark saying goodbye to each other shouldn't mean losing your world-class health care" at UPMC hospitals.
There are close to a thousand local attorneys worried that that's exactly what it means.
David Blaner, executive director of the Allegheny County Bar Association, said that, for more than 50 years, the association has offered its members, even those in solo practice, a selection of different plans through Highmark Inc.
Under its contract with Highmark, those attorneys can enroll as part of a much larger group that includes such associations as the SMC Business Councils of Pittsburgh, the Chamber of Commerce Service Corp., the county and state medical societies and a number of local nonprofits.
That doesn't necessarily mean their premiums are lower, Mr. Blaner said; in fact, they may be higher than if coverage is purchased directly from an insurer.
But it does carry some key advantages, most importantly an assurance that they can get coverage, regardless of whether they have a pre-existing condition -- advantages that make Mr. Blaner believe that members will not want to switch insurers, since neither UPMC Health Plan nor the major national insurers contracting with UPMC offer a similar arrangement.
"Obviously that's a huge safety net for us and our members and we value that through our relationship with Highmark," said Mr. Blaner.
It's a safety net that he believes his members will not want to give up. "At this point, we don't believe there are any other options," he said.
Tom Henschke, president of SMC Business Councils whose members range from independent landscapers to financiers specializing in mergers and acquisitions, said their members -- which number just under 1,000 -- may face a similar dilemma.
"What our members are saying is that they like their Highmark coverage and they want to keep their doctors." A Highmark-UPMC dissolution would seem to preclude that, but Mr. Henschke said "we haven't had that conversation yet."
For now, he said there are just too many variables to know what to do, with various legislative initiatives and the uncertainty about whether the contract's one-year run-out period after June 30 will include physician services.
"If you're a business owner, you need more information before you can make the best business decision, and what that is, is not exactly clear," he said. "It's too early to speculate on what people are going to do or how they're going to react."
Both executives agreed their membership has been a big plus to the larger field of insurers.
Premium hikes, which in some cases went up 60 percent in two years, have now stabilized in the 4 percent-to-6 percent range, Mr. Blaner said.
But both also say their members like dealing with Highmark.
"My understanding is that people's first choice is to keep that, because they understand it and it works for them," said Mr. Henschke.
Mr. Blaner said a survey done by their insurance broker showed that "eight of 10 said they wanted to stay with Highmark."
Much can happen before the expiration of the contract between Highmark and UPMC next summer, including intervention by the state insurance commissioner that could extend the existing contract.
And come 2014, the national health care overhaul's health insurance exchanges will prohibit insurers from denying coverage because of a pre-existing medical condition.
But, Mr. Blaner pointed out, that leaves a six-month window of uncertainty beginning July 1, 2013, when their Highmark plans may not include in-network access to UPMC.
And that's assuming Highmark prevails in its position that the one-year run out period from next July 1 includes physician services.
"If we can get from 2011 to 2014 without disruption to the membership," he said, "that will be a major success."
First Published December 2, 2011 12:00 am
