Highmark resolves stalemate with St. Clair Hospital [The Pittsburgh Tribune-Review]

July 24--Highmark Health Services and St. Clair Hospital have ended a months-long contract battle that prevented Highmark insurance customers from receiving care at a McMurray outpatient clinic St. Clair opened in June.

Highmark, the state's largest health insurer, said it and the Mt. Lebanon hospital system signed a multiyear contract on Wednesday, giving Highmark members full access to all St. Clair facilities.

The insurer's network of six hospitals in the Pittsburgh region were not a point of contention during contract negotiations, Highmark spokesman Aaron Billger said.

Allegheny Health Network includes Jefferson Regional Medical Center, about 12 miles away from St. Clair. Highmark owns an outpatient clinic on Route 19, about two miles from St. Clair's outpatient center.

"It came down to reimbursement at a fair price," Billger said of the contract negotiations. "It's about getting to a balance of what the institution's needs are and keeping care affordable for our members."

St. Clair officials declined to comment.

In late May, the hospital announced that it and Highmark, negotiating since February, reached an impasse that would prevent patients with Highmark insurance from going to the clinic, which opened June 3.

James McTiernan, a health care consultant with Downtown benefits firm Triad Gallagher, said negotiations between Highmark and hospitals throughout Western Pennsylvania are contentious, but not because the insurer now is a hospital competitor.

"Any negotiations are going to be tough because money is tight," he said, referring to the push by insurers to slow the rise of health care costs.

Billger said Highmark wants members to access all hospitals in Western Pennsylvania, regardless of whether they're part of Allegheny Health Network, which owns St. Vincent Health System in Erie in addition to five West Penn Allegheny Health System hospitals and Jefferson Regional.

Highmark is negotiating reimbursement contracts with several area hospitals, though Billger declined to specify the institutions.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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