The Herald, Sharon, Pa.

Local News

July 16, 2014

Health care fight spares area

MERCER COUNTY — Highmark and UPMC found one thing they agree on in their truce accord: They’re ongoing feud, which has softened in recent weeks, will not affect services provided outside of the greater Pittsburgh area. That area includes all of Mercer and Lawrence counties.

A little over two weeks ago the two health giants reached an accord whereby UPMC agreed to allow some Highmark insurance customers to continue using its doctors and facilities at in-network rates. The deal was hammed out with the help of Gov. Tom Corbett and Attorney General Kathleen Kane.

A contract between the two companies ends Jan 1. The fear was most Highmark subscribers would lose in-network access to UPMC doctors and hospitals after Dec. 31. Losing the in-network access would mean those Highmark customers would be paying higher rates.

After the deal Highmark said a small fraction of its 3.2 million insurance subscribers in western Pennsylvania will be affected.

Tucked inside the agreement it specifically states: UPMC services provided outside the greater Pittsburgh area (defined as Allegheny, Beaver, Butler, Washington and Westmoreland counties) will remain in-network for Highmark subscribers.   

Mercer and Lawrence counties are identified as being outside of that area.

“Highmark members in those counties should see little to no impact in their access to care,’’ said Aaron Billger, a Highmark spokesman said Tuesday.

In Mercer County that means the hospital systems of UPMC Horizon, Sharon Regional Health System and Grove City Medical Center will be considered in-network. There had been a fear that people who use UPMC Horizon who have Highmark insurance wouldn’t be considered in-network. Under this deal, they will be.

“UPMC Horizon will have a contract with Highmark,’’ Billger said.

There had been confusion over what hospitals that would be impacted.

Under the deal, after Jan. 1 2015, Highmark will no longer have UPMC’s flagship hospitals in the greater Pittsburgh area, including Magee-Womens Hospital, UPMC Presbyterian Shadyside, UPMC Passavant, UPMC East, UPMC St. Margaret and UPMC McKeesport in its network.

People 65 or older, or are covered by Medicare, Medicaid or the state’s Children’s Health Insurance Program will not be affected.

Two of UPMC’s specialty hospitals, Children’s Hospital and Western Psychiatric Institute and Clinic, will remain in-network to Highmark subscribers because they are the only institutions of their type in the greater Pittsburgh area.

All of this came to a head as Highmark had been given a July 1 deadline by the state Department of Insurance to say whether it could extend the contract with UPMC or not.

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