Highmark-UPMC agreement raising new questions

The separation agreement between UPMC and Highmark Inc. has begun raising questions, barely two weeks after Gov. Tom Corbett announced the pact.

In a message sent Wednesday to health insurance brokers, UPMC picked apart Highmark’s interpretation of their separation agreement and suggested Highmark had skipped over critical details in an advertisement. The questions prompted state Rep. Tony DeLuca, a Democrat from Penn Hills, to ask Corbett and other administration officials for clarification of the Highmark-UPMC separation agreement.

“It would be helpful to me as well as to all members of the House Insurance Committee to have the process clearly and concisely outlined as to how these disputes will be resolved,” DeLuca wrote in the letter. DeLuca questioned a number of issues about the agreement, including whether an appeal process had been created for Allegheny Health Network cancer patients who preferred to be treated by UPMC doctors.

DeLuca was responding to a story about the latest Highmark-UPMC dust-up, which appeared in the Pittsburgh Post-Gazette. “… It appears that these specialty care, emergency care and continuity of care issues are not only far from resolved, but demand the attention of the parties who were at the table in finalizing the consent decree and those who will make sure the consent decree is carried out,” DeLuca wrote.

In a note widely distributed to insurance brokers and others, UPMC clarified a number of points in a Highmark advertisement, including Highmark’s assertion its members will continue to have in-network access to any UPMC hospital emergency room. “Only until stabilized for transfer to an in-network facility under protocols yet to be announced,” UPMC noted.

UPMC spokesman Paul Wood said the hospital system was simply providing clarification to the Highmark ad.

“Highmark has a long track record of disingenuous ads,” he said. “This ad was intended to confuse the public. We’re going to do what we always do, and that is be persistent in telling the truth and providing clarity.”

The positive response to UPMC’s communication from business owners, brokers and doctors “has been astounding,” he said.

Highmark spokesman Aaron Billger said talks with UPMC were continuing on details of the agreement. On June 27, Corbett announced the Highmark-UPMC transition agreement, which was reached through a five-year consent decree.

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