News for Immediate
June 27, 2014
Governor Corbett, Attorney General Kane Announce Highmark and UPMC Agreement to Key Conditions Protecting Patients and Consumers
Terms in Consent
Decree Will Put Patients First in Western PA
Harrisburg − Governor Tom Corbett and Attorney
General Kathleen Kane announced today that Highmark and UPMC have reached a
comprehensive transition agreement that covers how and where patients can
receive health care after the contract between the two organizations expires in
some time, the people of western Pennsylvania have been concerned about where
and how they will receive their health care come Jan. 1, 2015,” Corbett said.
“We listened to all parties, and through a shared commitment to protecting
patients and insurance consumers, designed the framework for a transition plan
that focuses on putting them first.”
greater access to care and transparency for Western Pennsylvania patients has
been a top priority since I took office,” Kane said “For all of us, patients
must always come first. The joint effort of this office and the Governor’s team
proves that when we work together, we can accomplish a lot.”
plan is a result of ongoing work from Attorney General Kathleen Kane’s Office
and coordination of that office with Governor Corbett’s Leadership Team led by
Insurance Commissioner Mike Consedine and Health Secretary Michael Wolf. It
addresses key areas of critical concern to patients and policyholders,
- Continuity of care:
UPMC and Highmark agree that the care of a Highmark member in the midst of
a course of treatment at UPMC will be continued on an in-network basis for
as long as the patient and his or her doctor deem it necessary.
- Vulnerable Populations:
UPMC and Highmark agree that vulnerable populations such as consumers age
65 or older, Medicare, Medicaid, CHIP, Medigap and Signature 65 will not
be impacted and continue to have access to UPMC providers and
Hospitals/Physicians: UPMC and Highmark are to
negotiate a contract for Western Psychiatric Institute and Clinic; UPMC
Bedford; UPMC Venango (Northwest), Hamot and Altoona; and other UPMC
unique services that may be delivered outside the Greater Pittsburgh area
or any future acquired hospital by UPMC. The still ongoing contract for
Children’s Hospital is not impacted.
- Emergency Services:
UPMC and Highmark will negotiate an agreement so that emergency and trauma
services will continue to be accessible at in-network rates at UPMC and
Allegheny Health Network hospitals.
- Local Community Needs:
Highmark members will have ongoing access to unique UPMC local providers
and services where the patient’s treating physician believes the patient
needs such services and they are not available from another source.
Highmark members will have ongoing access to UPMC providers for cancer
treatment on an in-network basis if a patient’s treating physician makes
that determination. That may include treatment of illnesses resulting from
cancer, such as mental health, endocrinology, orthopedics and cardiology.
This includes UPMC joint ventures, physician services provided at or on
behalf of independent hospitals, as well as services provided through
Hillman and at Magee.
- Safety Net:
UPMC and Highmark agree that there will be a one-year safety net beginning
January 1, 2015, for any existing UPMC patient and Highmark subscriber who
is unable to find alternative physicians and services in their area.
indicates that UPMC and Highmark will each contribute $2 million for the
Commonwealth to use for outreach and education during the transition and to
cover the state agencies’ costs in reaching these agreements.
Highmark and UPMC have
also both agreed to not engage in any advertising that is unclear or misleading
in fact or by implication to consumers.
together as a team to represent the interests of our consumers, this agreement
puts the needs of patients and consumers first,” Corbett concluded. “The
team of the Insurance Department, Department of Health and the Office of
Attorney General have worked together to represent the best interest of
Pennsylvania’s consumers − this is government at its finest.”
agreement also incorporated the considerable input and constituent-focused
advocacy of western Pennsylvania legislators who have also been integral in
working toward a solution on the issue.
will help many families whose health care and pocketbooks were in jeopardy for
far too long,” Kane added. “Today’s agreement is the first step in what will be
a long process, and I will ensure that we will not waver in our commitment to
patients and the region.”
transition agreement is significant in terms of both its scope and duration.
this is not a contract extension between the two parties at this time, today’s
agreement offers a framework for the transition plan that will be filed by
Highmark with the Pennsylvania Insurance Department on July 31, 2014.
agreements between Highmark and UPMC are part of consent decree filings with
Commonwealth Court and will be available at on both the Commonwealth Court’s
website and the Attorney General’s website (www.attorneygeneral.gov).
Media contacts: Christine Cronkright,
Governor’s Office, 717-783-1116
J.J. Abbott, Office of the Attorney General, 717-787-5211