FACTS ABOUT THE NEW UPMC/HIGHMARK CONTRACT

What the new contract does

  • Does more than just extend the current consent decree, which only gave Highmark patients in certain vulnerable groups (like seniors, cancer patients, people in the middle of treatment) access to UPMC.
  • This new ten-year contract allows Highmark to offer full in-network access to UPMC to any of its members (although it can choose to sell some plans that exclude UPMC– see next section).
  • More than 1 million Highmark plan members in Western Pennsylvania can go to UPMC doctors and hospitals that otherwise would have been out of network.
  • Patients who were going to lose access to their current UPMC doctors and hospitals on June 30 no longer have to worry.

BUT... (What it does NOT do)

    • Not all Highmark patients will have in-network access to UPMC. Over 300,000 people, including 50,000 Pittsburgh-area teachers, who are enrolled in Highmark’s lower-priced Community Blue and Connect Blue plans still won’t have access to most UPMC hospitals or Hillman Cancer Centers. (Highmark keeps premiums low on these plans by excluding higher cost providers, like UPMC.)

 

    • Patients with UPMC health plans still won’t have in-network access to most Allegheny Health Network facilities, including West Penn Hospital and Allegheny General Hospital.

 

Why we still need legislation

  • UPMC can still refuse to contract with other insurers that have moved into the region in recent years, subjecting patients with other plans to the same stress and uncertainty as it did to those with Highmark.
  • When the contract expires in ten years, we could be in exactly the same situation we were before.
  • The bills put forward by Sen. Costa and Rep. Frankel will ensure that health giants like UPMC and Highmark have to accept “any willing insurer,” so this situation never happens again.
  • Costa’s bill would also establish a Health Care Competition and Oversight Board to ensure that the market for healthcare in Pennsylvania serves the interests of consumers– this would help address future issues that come up.

Why we still need oversight by the Attorney General

  • The new contract does not force UPMC to act like a true nonprofit. Over the course of its separation with Highmark, UPMC consistently prioritized growth and market share over the well-being of its patients. We should expect that this growth-at-all-costs attitude will continue to drive its future decisions– ongoing oversight from the state Attorney General would ensure that patients are protected.

Who has access to which providers?

Things to know

  • Highmark divides its plans into two categories:
  1. “Broad access” plans (like Freedom Blue & Security Blue) have a wider network of doctors and hospitals, but tend to cost more.
  2. “High performance” plans (like Community Blue & Connect Blue) cost less, but have a narrower network.
  • Highmark and UPMC also agreed to “emergency department protection,” which means they can’t charge patients exorbitant rates if they go to an out-of-network emergency room. However, this only applies to emergency department charges- once a patient is stabilized, they’d have to transfer to an in-network facility or face massive bills.

What can I do?

Sign the petition

Tell our public officials to ACT to protect health care access for our families and neighbors.

Tell Your Story

Has the UPMC-Highmark “divorce” affected your access to care? Tell us your story.

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Help spread the word!

Circulate a petition

Download and print a paper copy of the petition below. Return any number of signatures to:

Controller Chelsa Wagner
Allegheny County Court House
436 Grant Street
Suite 104
Pittsburgh, PA 15219

How has the UPMC-Highmark “divorce" failed Western PA residents?

ACCESS DENIED

In Allegheny County, many Highmark members lost in-network access to UPMC at the end of 2014. However, consent decrees kept emergency, trauma, and cancer services in-network, and limited the amount that Highmark and UPMC could charge out-of-network patients. The consent decrees also allowed patients in the middle of treatment and those enrolled in Medicaid, CHIP, and Medicare Advantage to remain in-network. When the consent decrees expire on June 30, 2019, these protections will end.

SENIORS SHUT OUT

The end of the consent decrees will have a significant impact especially on seniors in the region. Allegheny County has one of the largest concentrations of seniors covered by Medicare Advantage in the country. As of November 2018, more than 162,000 of the county’s seniors were covered by Medicare Advantage. Many of these seniors will find their longtime doctors and hospitals out-of-network when the consent decrees expire.

‘HARSH’ PRACTICES

UPMC has gone a step further, saying it would require the newly out-of-network Highmark Medicare Advantage patients to pay in advance, and partial payments or payment plan arrangements will not be accepted.  Steve Foreman, a professor of health care administration at Robert Morris University, described UPMC’s prepay requirement as “unusual” and “harsh,” telling the Tribune-Review, “He never has seen any insurers force out-of-network patients to pay their entire bills in full before receiving a medical service.”

SHOCKING BILLS

For those with out-of-network insurers, hospitals can charge exorbitant rates, then bill patients for the difference between what the insurer is willing to pay and the hospital charges – a practice known as “balance billing.” For instance, a patient with Highmark insurance who finds herself in a UPMC emergency room would be charged the out-of-network rate; if that’s less than what Highmark is willing to pay, she would have to pay the difference, which could run tens of thousands of dollars. (The same would be true for a patient with UPMC insurance who ends up in an Allegheny Health Network emergency room.)

UNCHECKED EXPANSION

UPMC and AHN have announced plans to spend a combined $3 billion on new, tax-exempt hospitals in the region in the coming years, hospitals to which many in our region will be denied access.

WALLS PUT UP

UPMC has locations in four foreign countries and markets itself to patients around the world. Yet those in its own backyard will be denied its “Life Changing Medicine” if they choose the wrong insurer. As health care consumers from around the world flock to Pittsburgh for “World-Class Care,” it is unconscionable to build walls between our own residents and the doctors and hospitals that serve them best.

Take Action

Legislation introduced in Harrisburg would require that health networks like UPMC and Highmark which operate as both health care providers and insurers cannot turn away patients covered by another insurer that is willing to pay for their care. Ask your State Senator to support Senate Bills 310 & 311 by Sen. Costa, and your Representative to support House Bills 1211 & 1213 by Rep. Frankel. Call today!

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