Unless the two local health care giants come to a resolution, 4.8 million people in Southwest and Central PA could have to part ways with their preferred providers and critical health services beginning June 12, 2012. This includes people insured through their employers with Highmark, as well as out-of-state Blue Cross Blue Shield Plans, in addition to over 130,000 insured as individuals with Highmark (UPMC Health Plan doesn't currently offer individual insurance plans).
- Highmark’s contract for services at certain UPMC hospitals are not currently affected, including UPMC Hamot in Erie (expires in 2013), UPMC Mercy (expires in 2015) and Children’s Hospital (expires in 2022). Access to other UPMC facilities, including specialty hospitals such as Hillman Cancer Center and Magee Women's Hospital, is impacted, however, as things stand now.
- If the contracts are not re-negotiated, Highmark and other Blue Cross Blue Shield customers will still have access to UPMC hospitals and physicians, but only by paying out-of-network rates which could make it unaffordable for most.
Democratic lawmakers from Western Pennsylvania, including State Representatives Tony DeLuca (Penn Hills), Brian Barbin (Cambria) and Dan Frankel (Squirrel Hill), are currently seeking legislative solutions to the stalemate between health care giants UPMC and Highmark. They are also calling for Governor Tom Corbett to get involved.
Use of a provision of state law known as Act 94 of 1975 is being considered by the Pennsylvania Insurance Department to delay the June 2012 deadline by six months, giving time for facilitation of possible continued negotiations between Highmark and UPMC, as well as more time for PA consumers and employers to consider alternative healthcare options. The Insurance Department cannot under current law force Highmark and UPMC to enter into a contract, but could potentially extend any contract termination until at least the end of April in 2013.
Highmark / UPMC FAQ (Pennsylvania Insurance Department)
Local Lawmakers Seek Legislative Solution to UPMC-Highmark Stalemate (Plum-Oakmont Patch)
UPMC Seeks to Assure on Medicare, Medicaid (Pittsburgh Tribune Review)