Highmark Inc.’s plans for what will happen when its contract with UPMC expires on Dec. 31 were released Tuesday by the Pennsylvania Insurance Department, which has been reviewing the plan since it was submitted in late July.
Among the provisions released Tuesday, according to Highmark:
- Highmark said it will create a new tier of Community Blue insurance to provide access to some UPMC services at a higher cost than in-network and make other UPMC services out-of-network at a higher cost.
- In-network access for emergency care at all UPMC facilities for Highmark members, at least until stabilization.
- In-network access to Children’s Hospital of Pittsburgh of UPMC, Western Psychiatric Institute and Clinic, and UPMC Mercy.
- In-network access to 80 percent of UPMC physicians at UPMC hospitals outside of the five-county region and non-UPMC community hospitals in and around Pittsburgh. That includes UPMC Bedford, UPMC Altoona and UPMC Hamot.
- A continuation of care for Highmark members who are seeing UPMC doctors and a transition to doctors and facilities that are not from UPMC.
“In order to reduce potential member confusion, Highmark also will work with UPMC to develop a process for the prompt resolution of any member issues that result from the transition of providers,” Highmark said in a statement.
A consent decree between UPMC and Highmark was announced June 27 after negotiations with Gov. Tom Corbett and Attorney General Kathleen Kane. The transition plan was part of the Insurance Department’s conditions to allow Highmark to purchase the West Penn Allegheny Health System, which is now part of Allegheny Health Network.
Highmark Health Plan President Deb Rice-Johnson said the transition plan provides a patient-centered approach to the transition, ensuring access and no disruptions of coverage.
“What the plan does is it brings clarity to the consent decree,” Rice-Johnson said.
“Highmark’s transition plan, which was submitted late in July, underwent intensive financial and legal review, which focused on consumer concerns,” Insurance Commissioner Mike Consedine said in a prepared statement. “We will continue to be focused on consumers and will seek to provide clear information as well as to hold Highmark to the elements of their plan.” Consedine wasn’t immediately available for further comment.
The department has created a special website, StayInformed.pa.gov, that will provide answers to questions about the transition plan. Highmark has also created a website, YourNetwork2015.com. Highmark wanted to reassure consumers about the upcoming changes.
“Taking the confusion out of the marketplace was very important to us,” Rice-Johnson said. The Department of Insurance will also address questions on its website, although a spokeswoman emphasized it was Highmark’s transition plan.
“Our transition plan will allow us to work with employers with their specific needs, and work with and engage with their employees and family members in the transition,” Rice-Johnson said.
UPMC spokesman Paul Wood said the health care system had some concerns over some passages in the transition plan to make sure the provisions were clear.
“We will be working with the Department of Health, PID (Pennsylvania Insurance Department) and the Attorney General to make sure everything is appropriately clarified,” Wood said.
Wood said: “The overall key point is the Highmark transition plan really codifies or puts in place the simple fact that UPMC flagship hospitals are out-of-network for Highmark subscribers.”
Date: September 03, 2014