Website Aims to Clear Confusion of Highmark/UPMC Contract Termination

Dec 11, 2014

The state is launching a website to help consumers through the impending termination of a contract between a Western Pennsylvania insurer and the region's dominant hospital and outpatient network.

Officials said they're posting information to stayInformed.pa.gov about changes taking effect Jan. 1 when most Highmark subscribers lose in-network access to UPMC doctors and hospitals. This change has raised many questions, and they have been fielded through the PA Department of Insurance.

“We often are asked ‘will I continue to be able to see my doctor?’ and each individual answer would be different depending on your healthcare and treatment going forward,” said department spokeswoman Rosanne Placey. “[Another question] is what facilities will continue to be available to me and at what cost?”

Most UPMC hospitals in the Pittsburgh region will be considered out-of-network for Highmark subscribers. Exceptions include UPMC Mercy and Children's Hospital of Pittsburgh of UPMC, which are governed by separate contracts.

Highmark has said fewer than 10 percent of its 3.2 million subscribers used a UPMC doctor or facility in the last year.

UPMC refused to extend the in-network provider agreement with Highmark after the insurer acquired seven hospitals from Erie to Pittsburgh.