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State Representative Wants Specialty Hospital Exception in UPMC-Highmark Dispute

Allegheny County Representative Dan Frankel wants to carve out an exception in the contract dispute between the insurer Highmark and the healthcare provider University of Pittsburgh Medical Center. He says specialty hospitals that excel in treating specific segments of the population, like UPMC's Children's hospital, or certain illnesses, like the Hillman Cancer Center, should continue to be accessible to patients who are not in-network.

Beyond access, Frankel argues that in a time of rising health care costs, expecting Highmark, which is purchasing West Penn Allegheny Health System, to duplicate UPMC's institutions with "another women's hospital, another psychiatric hospital, is a waste of community resources."

The bill would authorize any insurance company to include those facilities as in- network. Frankel says it would preserve competition among insurance companies like Aetna, Highmark, UPMC and Health America, while keeping UPMC from "cornering the market" on specialty hospitals. Frankel says he has spoken with UPMC and that the healthcare provider disagrees and wants the facilities out-of-network. Frankel calls that "absurd" because "the costs would be exorbitant—in some cases two or three times an in-network reimbursement."

While UPMC and Highmark cannot be forced to work out their contract dispute, Frankel says there is precedent for the legislation. When Children's Hospital and UPMC merged in 2001, UPMC was barred from restricting access to Children's through a consent decree with the state Attorney General. He's hoping this legislation accomplishes the same thing. Frankel says the bill is getting bipartisan support and he plans to introduce it within the next week.