Pittsburgh, PA – In anticipation of the conclusion of the consent decrees that guide the relationship between UPMC and Highmark, Governor Tom Wolf today announced a landmark agreement between UPMC and Highmark that creates terms to provide access to critical, unique services and to certain hospitals in the commonwealth.
“My commitment has always been to put the patients and communities served by UPMC and Highmark first, and make sure consumers who need vital, at times life-saving health care, can get it,” Governor Wolf said. “I want to thank both companies for sharing this commitment, and for working together to reach this agreement for the benefit of so many people in western Pennsylvania.”
UPMC and Highmark have been working under consent decrees signed in 2014 that provide continued, in-network access to care for customers of both companies. However, these agreements will expire at the end of June 2019, at which time, without today’s terms, commercial customers of Highmark would be denied in-network access to these community and specialty UPMC providers and facilities.
“This landmark agreement means consumers of both companies will have in-network access to facilities that provide one-of-a-kind services,” Governor Wolf said. “This is medical care that simply is not available anywhere else in the region, and denying affordable access to this vital care is just not acceptable. I am pleased that with this agreement access will continue.”
The agreement ensures in-network access for customers of both companies to facilities that provide one-of-a-kind services. These include:
- Western Psychiatric Institute
- UPMC Center for Assistive Technology
- UPMC Center for Excellence for treatment of Cystic Fibrosis
- Certain highly specialized transplant services only available through UPMC
- Selected UPMC Joint Ventures with community facilities, including oncology
Highmark enrollees will also have continued access to the Children’s Hospital of Pittsburgh under the terms of an existing agreement.
“Allowing Highmark insurance customers to seek the unique care provided at these facilities at in-network prices will allow consumers continued access to these important services,” Acting Insurance Commissioner Jessica Altman said.
The agreement also provides in-network access to certain UPMC hospitals in the commonwealth. These include:
- UPMC Altoona
- UPMA Bedford
- UPMC Northwest
- UPMC Kane
- Carlisle Regional
- Lancaster Regional
- Heart of Lancaster
- Memorial Hospital of York
- Certain UPMC Susquehanna Hospitals
“Similar to the unique services available regionally only at one facility, in these communities basic health care is not available anywhere but at the UPMC hospitals. Keeping in-network access for Highmark customers means they will continue to have access to nearby critical health care,” Altman said.
“With the end of the Consent Decree in 2019, this agreement provides clarity regarding the unique and highly desirable medical services only available at UPMC’s world-class facilities,” said David Farner, executive vice president, UPMC, and chief strategy and transformation officer.
“We thank the Governor and the Insurance Department for their efforts to support our commercial members,” said Deb Rice-Johnson, president of Highmark Inc. “Our network of hospitals and physicians is one of the largest in the state. Access to these community hospitals reinforces the value of having choice in health care options for keeping care close to home for our members and community-based.”
Consumers who live in communities where a choice of providers, facilities, and services is available will have to make a choice when the consent decrees expire at the end of June 2019.
“The bottom line is this agreement means all health care consumers in western Pennsylvania will continue to have access to vital health care, and the uncertainty that has plagued so many people for several years can now end,” Governor Wolf said.
J.J. Abbott, 717-783-1116
Ron Ruman, Insurance, 717-787-3289