What the UPMC-Highmark truce does and doesn’t mean for patients
Patients who severed ties with longtime doctors are hopeful they can return to the physician teams who know them best.
Others already have begun new treatment plans with new sets of doctors and are unsure how to proceed.
Some expressed frustration that they switched insurance plans away from Highmark to avoid being caught in the middle of the corporate feuding, only to learn now they won't have to worry about a prepay-in-full rule they'd been told would take effect at most UPMC facilities next week.
While the truce was welcome news for many, "it doesn't solve everything, and it actually creates new questions, new issues that are going to take a while to resolve," said
RELATED: UPMC, Highmark reach 10-year deal for patient coverage
Several patients said they remain skeptical and unsure of the deal's impact until they get guarantees directly from their insurers and doctors.
McKendree said, in coming weeks, advocates and counselors like him as well as insurance brokers and other industry observers will be paying close attention to the specific terms, costs and limitations folded into the new UPMC-Highmark contract, which takes effect Monday and expires in 2029.
The private contract, which was not made public, awaits approval from the state
The public is invited to learn more at a meeting organized by APPRISE set for
"There are still some details that have to be enumerated before we know exactly what to expect," McKendree said. "We still have a lot of unanswered questions."
In the meantime, here are some things we do know:
Does the truce guarantee that all patients with UPMC or Highmark insurance plans can go to doctors and hospitals in both networks?
No, not for everyone. The truce is broad in that it applies not only to Medicare-eligible and cancer patients but to patients of every age and those on individual as well as employer-based plans -- as long as they are enrolled in so-called "broad-based" plans, or plans that include at least partial benefits to other networks. Highmark also agreed not to charge patients more for care received at UPMC facilities than they do for care within Highmark's
The truce means that both systems must at least offer every type of patient the choice of a plan that includes access to both UPMC and
But, under the new contract, UPMC and Highmark agreed they each have the right to continue rolling out narrow or exclusive network plans that specifically exclude the other. It's unclear how many of those plans will materialize and how their costs may differ. Some exist already and tend to cost less than broad-based or PPO options.
So, who is left out?
Narrow-network plans such as Highmark's fast-growing Medicare Advantage Community Blue
The truce also is limited geographically. It only applies to a 29-county region of
Contracts in
Exceptions that will remain accessible to everybody, no matter their insurance card, include:
I switched plans because of the looming split. Now that there's a truce, can I switch back?
For most people, the answer is no, you will not be able to change plans until the next scheduled enrollment period.
A select group of Highmark-insured seniors and people with disabilities will have the chance to switch sooner.
The
Everyone else will have to wait until the next scheduled enrollment period, which begins
Is Shapiro's fight against UPMC over?
In terms of active litigation, yes. With the truce, Shapiro said he was dropping what's left of his legal case against UPMC in Commonwealth Court. Less than two weeks ago, Judge
As recently as
On Monday, Shapiro said he appreciated the last-minute hustle by the executives and boards of both UPMC and Highmark and said the truce should usher in a new era of cooperation in the name of public interest. Shapiro emphasized that, though his legal fight is over for now, he and his team will continue to exercise oversight on UPMC, Highmark and "purely public charities" statewide.
"It doesn't mean that our oversight responsibilities and the other work we do will cease. That will, of course, continue," Shapiro said, "but that actual lawsuit will be withdrawn."
How can I learn more about how this affects me and my loved ones?
Highmark and UPMC urge consumers to contact customer services representatives and their local doctors. Insurance brokers also are standing by to help. Medicare-eligible patients can get free counseling at APPRISE by calling 412-661-1483. Reach Highmark's customer service at 800-294-9568 or www.highmark.com/. Reach
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