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UPMC, Highmark Agree To Extend In-Network Access For 10 More Years

Sarah Boden
90.5 WESA

Two western Pennsylvania health care giants have a deal that averts the looming breakup of their business relationship, an agreement that prevents disruption and higher costs for many patients.

*This story was updated at 2:26 p.m. on June 24, 2019 to include more information. 

State Attorney General Josh Shapiro announced Monday that UPMC and Highmark have a new contract that gives Highmark insurance customers in-network access to all UPMC doctors and hospitals for the coming decade.

Shapiro, who earlier this month lost a court decision in his effort to extend the companies' relationship, called the agreement good deal for patients and the public.

“[UPMC and Highmark] have pledged directly to me and to each other that they will no longer act as adversaries, but instead work as allies and we will all be better off for it,” said Shapiro.

UPMC had opposed renewing their agreement in 2012 after Highmark purchased what's now Allegheny Health Network and became what UPMC viewed as a competitor in providing health services and insurance coverage. That, in 2014, led to a five-year consent decree that expires Sunday.

If the decree were to expire without a new agreement, many people with Highmark insurance would lose in-network access to UPMC providers, including patients with serious and complex health conditions.

Paul Wood, UPMC’s vice president of communications, said that one of the main sticking points that was resolved with the new agreement is that Highmark insurance would not charge its members higher rates for care at UPMC facilities, versus those at Allegheny Health Network.

“No business is going to enter into a contract that diminishes it, and no businesses is going to allow itself to be played against itself,” said Wood.

UPMC and Highmark would not disclose the agreed-upon rates. Nor would they make the contract available to the public.

As a result of this agreement, Highmark said it would drop a five-year-old lawsuit against UPMC over oncology billing.

“It allows everybody to get on with their lives, and to focus on what’s good for their patients and the members,” said Highmark CEO David Holmberg.

Shapiro also agreed to drop the lawsuit he filed against UPMC back in February. It alleged the health care system was abusing its tax-exempt, non-profit status by Highmark customers in-network access.

The new agreement starts July 1, 2019, the day after the consent decree that was signed in 2014 expires.

The Associated Press contributed to this report. 

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.