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UPMC-Highmark Agreement

Senator Wayne Fontana's News & Views

UPMC - HighmarkLast week Governor Wolf announced an agreement between UPMC and Highmark that will provide in-network access to community healthcare facilities that provide one-of-a-kind services.  UPMC and Highmark have been working under consent decrees since 2014 that provide continued, in-network access to care for customers of each company.  The original agreement expires on June 30, 2019, at which time, without these agreed to terms, commercial customers of Highmark would have been denied in-network access to specialty UPMC providers and facilities.

The agreement ensures in-network access for customers of both UPMC and Highmark to facilities that provide one-of-a-kind services including:

  • 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 customers will continue to have access to Children’s Hospital of Pittsburgh under terms of an existing agreement.

I want to thank the leaders at both UPMC and Highmark for finding a way to make this work and Governor Wolf for keeping the parties at the table and relentlessly pursing this workable solution.

I’ve been proud to work with my colleagues, Senator Jay Costa and Senator Randy Vulakovich, on legislation to address contractual disputes between integrated delivery networks by focusing on hospitals operating as part of an integrated delivery network – where a large health system and insurance carrier/health plan operate under the same corporate structure.  It would require hospitals and physicians operating as part of an integrated delivery network to contract with all insurers, so that consumers would not be denied care, or worse, abandoned mid-treatment, simply because they hold one type of insurance over another.

Moving forward, I will continue to reach out to constituents and leaders of both health insurance entities to embrace even more cooperative strategies that elevate the quality, accessibility and flexibility of patient care services throughout our region.  All consumers should be afforded access to these vital services, regardless of which insurance card they carry.

 

 

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