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UPMC, Highmark Reach Transition Deal

A blueprint for what Pennsylvania officials hope will be a smooth transition for Highmark Insurance customers currently using UPMC doctors has been agreed to by both non profit organizations but the details have yet to be reached. 

“This as really been a bipartisan approach,” said Highmark CEO David Holmberg who just two weeks ago did not think such a deal was possible.  “This has been about everybody putting their swords down and doing the right things.”

The current contract between the two healthcare and insurance providers expires December 31, 2014, and thousands of customers feared they would immediately lose access to their doctors.  The deal announced Friday includes provisions for ongoing care including cancer treatments.

“Your access to that care is guaranteed in-network for as long as you and your doctors deem it necessary,” said Pennsylvania Governor Tom Corbett.  “Patients will make the call for what is best for their care.”

Hospitals referred to as “community hospitals” outside of the greater Pittsburgh area — UPMC Bedford, UPMC Venango, UPMC Hamot in Erie and UPMC Altoona —will remain in-network. UPMC facilities in and near Pittsburgh –such as UPMC Mercy and UPMC Passavant —will only be accessible if Highmark users are willing to pay higher out-of-network rates.  Emergency and trauma services will continue to be accessible at in-network rates, although the companies have not negotiated an agreement on that subject yet.

Children’s Hospital will also continue to be accessible by all insurance holders. UPMC Magee will not.

The two sides are under a consent decree to iron out any of the remaining details.  If they cannot come to an agreement the unresolved matters will be turned over to binding arbitration. 

People who are 65 or older, or are covered by Medicare, Medicaid or the state's Children's Health Insurance Program will not be affected.

UPMC is Western Pennsylvania's dominant network, with 22 hospitals and 400 outpatient sites. However, it has complained that Highmark is now a competitor, since the insurer recently acquired seven area hospitals from Erie to Pittsburgh.