Health insurer Highmark Inc. is trying to smooth the divide between its doctors and hospitals and rival UPMC by making it easier for members to get care from UPMC providers.
With the start of the fall open health insurance enrollment period, Highmark is offering a co-insurance plan option called Extra Out-of-Network Protection for PPO Blue coverage, which pays 80 percent of the plan’s coinsurance. UPMC is limited to billing Highmark members 60 percent of its charges at out-of-network facilities, increasing the total reduction to 80 percent of charges with the new option.
For a Highmark member who has already met their plan deductible, but not out-of-pocket maximum, a UPMC bill for $2,000 would be reduced to $240 with the new Highmark option, a savings of $320 to the member when compared to a plan without the option.
The fall enrollment period generally lasts through November with a Jan. 1 effect date for new coverage. The 60 percent cap on UPMC charges only lasts 30 days after care has been rendered. After then, the full charges are due, UPMC has said.
The UPMC hospitals that will be out of Highmark’s network starting Jan. 1 are Magee-Womens, St. Margaret, UPMC East, McKeesport, Passavant, Presbyterian and Shadyside, all in Allegheny County. But Highmark members will continue to have in-network access to Western Psychiatric Institute and Clinic, Children’s and Mercy hospitals, which are also located in the county.
Date: October 02, 2014