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Health Insurers Clarify Coverage Agreement

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In June, Governor Tom Corbett and other top state officials brokered an updated agreement between Highmark and UPMC. This agreement did not extend the contract between the two insurance giants but rather clarified the transition coverage for patients within the health systems represented by these carriers.

These UPMC Hospitals will continue to be in-network for Highmark users:
• Children’s Hospital of Pittsburgh UPMC — contract expires June 30, 2022
• UPMC Altoona, UPMC Bedford, UPMC Hamot/Kane Community Hospital, UPMC Horizon, UPMC Northwest, Western Psychiatric Institute and Clinic and Hillman Cancer Center — contract expires December 31, 2019
• UPMC Mercy — contract expires June 30, 2016

These UPMC Hospitals will be out-of-network effective January 1, 2015:
Magee’s Women’s Hospital of UPMC, UPMC East, UPMC McKeesport, UPMC St. Margaret, UPMC Passavant and UPMC Presbyterian-Shadyside.

Patients in the midst of care should also note:
• ER Access — Highmark members who seek care at any UPMC ER will be covered at in-network rates. This care includes the ER visit and any inpatient admission and continuity of care.
• Cancer Coverage — Highmark members have in-network access to all UPMC services, facilities, doctors and joint ventures for oncology care and complications of such care.
• Continuation of Care — All members in a continuing course of treatment with a UPMC provider can continue to receive care on an in-network basis at in-network prices.
• Seniors — All seniors have access to UPMC providers on an in-network basis.
• Safety Net — Any existing UPMC patient who is a Highmark member and who received in-network care from UPMC in 2014, can continue to receive care from that same provider in 2015, if those members are unable to find an alternative physician in their area.
• Physicians — In–network access provided to all UPMC-owned physicians located outside the five-county area of Greater Pittsburgh area, to all UPMC-owned physicians practicing at any of the UPMC exception hospitals or community hospitals, to all UPMC-owned oncology providers, to all UPMC pediatricians, and to all UPMC behavioral health providers.

For more information, contact me at 814/833-3200, 800/815-2660 or psmith@mbausa.org.