Highmark, UPMC Agree to Another Extension

A contract extension will allow more time to work out issues surrounding a dispute between insurer Highmark and the University of Pittsburgh Medical Center.   Governor Corbett says Highmark and UPMC will extend their agreement through the end of 2014.

The extension came after the Governor appointed David Simon, Vice President and Chief Legal Officer of Jefferson Health System in Southeastern Pennsylvania, to act as a mediator.  Governor Corbett thanked Simon and    members of the General Assembly for helping resolve the dispute over in-network coverage.

The dispute began after Highmark announced a takeover of the West Penn Allegheny Health System.      UPMC said that made Highmark a direct competitor to its system.

While Corbett did not sit at the negotiating table, he says he did encourage officials from both sides to find a resolution, or the state would get it done for them. He says he and the legislature were in agreement they were not going to let the people of Western Pennsylvania  live in with anxiety over the situation, keeping in mind both institutions were nonprofits that had received a great deal of benefit from that status.

He says they sent a clear message that these two institutions had a tremendous responsibility to deal with their disagreements and not affect the people of Western Pennsylvania the way they were.

The Governor’s office says Highmark and UPMC will be negotiating access to unique UPMC services beginning in 2015, including Western Psychiatric Institute, certain oncological services and community hospitals.

Lawmakers Stepping in to Highmark, UPMC Dispute

Time is running short to resolve the stalemate between Highmark and UPMC.   As it stands now, UPMC plans to end its contract with Highmark next year, meaning 20 hospitals and 27 hundred doctors would no longer be in network for the insurer’s subscribers.

State Representative Tony DeLuca (D-Allegheny), says he feels it’s the responsibility of the legislature and Governor’s administration to step forward and work to break the stalemate any way they can, for the good of the people they were sent to Harrisburg to represent.    

He’s proposing legislation (HB32) that would give the state Insurance Commissioner more authority to step into contract disputes between hospital systems and insurers.  Representative DeLuca says his bill would make it possible for the commissioner to require an expiring or terminating contract to continue for another term if it’s determined that action would be in the best interest of the citizens.

State Senate Democratic Leader Jay Costa says it’s not their practice to step into disputes between private entities, but this is a time when it’s necessary for the greater good.  He says they’ll be introducing comparable legislation in the State Senate

Representative Frank Dermody (D-Allegheny), House Democratic Leader, says concern about the dispute between UPMC and Highmark transcends partisan lines. He says the unwillingness of UPMC to continue talking through the disagreement with Highmark is causing problems for employers who must make long range decisions about health care for their employees.  He says it’s causing problems for workers and retirees who face uncertainty about access to health care and the likelihood of higher costs.

Rep Dan Frankel (D-Allegheny) has introduced legislation (HB1910) aimed at UPMC’s specialty hospitals. He says the measure would make certain any insurer could have access to Western Psychiatric Institute, Children’s Hospital, Magee-Women’s Hospital, The Hillman Cancer Center and the cancer network. 

The State House Insurance Committee has been holding hearings on the stalemate.