UPMC Hamot remains ‘in-network’ for Highmark customers

June 27--There are still details to be worked out, but a deal has been reached that will provide Highmark subscribers with access to UPMC Hamot for the next five years.

Pennsylvania Gov. Tom Corbett and Attorney General Kathleen Kane, accompanied by representatives from the two health care foes, announced a few minutes ago in Harrisburg that an agreement had been reached and a consent decree signed.

That agreement will provide in-network access to UPMC facilities for Highmark customers outside the Pittsburgh area, including UPMC Hamot in Erie and UPMC Northwest in Venango County.

While Highmark subscribers served by UPMC in the Pittsburgh area will have to find new doctors, the agreement does provide for continued care for Highmark patients who are receiving ongoing care for cancer or other serious conditions.

Emergency room visits, both inside and outside the Pittsburgh area, will also continue to be provided at in-network prices, according to the agreement.

"We are here today to announce a comprehensive transition plan that puts the patients and consumer first," Corbett said.

Here is a statement from the governor's office:

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 2015.

"For 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."

"Ensuring 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."

The 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, including:

- 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 facilities.

- Unique/Exception 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.

- Oncology: 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.

- The agreement 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.

"Working 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 â?? this is government at its finest."

The 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.

"This 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."

The transition agreement is significant in terms of both its scope and duration.

While 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.

The 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).

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