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UPMC and Highmark, A Confusing Truce

The announcement of a five-year consent decree brokered by state officials seems to be bringing a truce between Highmark and UPMC. What exactly will the agreement mean for policy holders? State Insurance Commissioner Michael Consedine highlights some of the major aspects of the decree to policyholders who may be experiencing some confusion with these “out of network” hospitals.

Some of UPMC’s most prominent hospitals are not in the network, included Magee Women’s Hospital. Commissioner Consedine says the largest issues surrounding the agreement are not which specialty hospitals will remain open in the network, but rather contingency of those already being treated by UPMC doctors, oncology care, and emergency services.

“Emergency service is a big one. You know, downtown Pittsburgh, you get to go to the nearest ER that you want to go to. There’s an emergency situation so we’re not putting patients in the position of making those choices in the midst of a medical crisis….from a patient perspective, you don’t have to make the choices to what ER may or may not be accessible, both at West Penn facilities and UPMC facilities.”

Commissioner Consedine also mentions the aspect of contingency of care the agreement mentions regarding those who are being treated by UPMC doctors. Those currently being treated by UPMC doctors will be able to continue care until treatment is complete.

“With three million people in Western Pennsylvania, there are three million hypotheticals that we could get with different conditions. We wrote for purposes this first step, the consent to creed, to be very broad, on continuity of care provisions.”

Hospitals such as Children’s Hospital of Pittsburgh and Western Psychiatric will still be accessible with Highmark insurance. 

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