A UPMC spokesperson said the problem had been resolved collaboratively, and UPMC “recognizes that we were able to reach this agreement with Highmark on a long-term network-based contract.” The agreement does not cover patients in other parts of Pennsylvania. A week before thousands of people lost access to UPMC providers, Highmark Health and UPMC agreed on a 10-year agreement allowing Highmark Blue Cross and Blue Shield patients to continue to be treated at UPMC facilities in western Pennsylvania. Following the Commonwealth Court`s decision of June 14, UPMC held an ingeniously productive meeting with Highmark to outline its offer to access the UPMC Hillman Cancer Center for Highmark members with a presumed or confirmed diagnosis of cancer or hematological. Highmark understood – as everyone else – that the UPMC Hillman Cancer Centre is as important to the well-being of the region as the UPMC Children`s and UPMC Western Psychiatric clinics. These discussions quickly spread to other areas and agreement was reached in the best interests of the patients and the communities we serve. UPMC believes in the importance of informed consumer choice and has always tried to ensure that, when UPMC is part of an insurance network, these members have full access to UPMC, with no contractual terms that are used to prevent or restrict the use of UPMC physicians and facilities. This important consumer issue has been addressed collaboratively, and the UPMC network will now be available to Highmark members. UPMC believes that we were able to conclude this agreement with Highmark through a long-term network contract. What is the impact of the Highmark and UPMC agreement on Medicare Advantage? The 10-year contract allows UPMC and Highmark to reserve the right to develop additional plans that exclude the other, as long as each patient has access to at least one plan that includes access to both systems. The agreement will end federal and regional lawsuits filed by Pittsburgh-based UPMC and Shapiro, in which Highmark intervened.
A UPMC spokesperson said the agreement does not require Highmark to include UPMC in all insurance products. But if it contains UPMC, it must include all UPMC physicians, hospitals and services, and Highmark members do not charge more a-pocket to go to UPMC than highmarks allegheny Health Network or other network providers. UPMC-Highmark TimelineJun 2011 – Highmark announces plans to expand beyond insurance activities by acquiring the former West Penn Allegheny Health System. The base of Highmark`s supplier arm, Allegheny Health Network.May 2012 – UPMC and Highmark enter into a mediation agreement to obtain in-network access for patients by December 31, 2014.27 June 2, 2014, Gov. Tom Corbett and the district attorney`s office intervened after Highmark and UPMC failed to agree on a contract. The two systems sign a five-year agreement, known as the “approval regulation,” in the hope of facilitating the transition for patients. October 30, 2014 – National health care and insurance supervisors are trying to keep Highmark in contempt for the introduction of a Monthly Premium Plan for Medicare Advantage 0, which explicitly excludes UPMC institutions. Commonwealth Judge Dan Pellegrini rejected the state`s request. November 30, 2015 – The Pennsylvania Supreme Court has ruled that Highmark Medicare Advantage members should have access to UPMC until at least June 30.
July 2019, 2018 – The state Supreme Court ruling that networked access to UPMC and Highmark will end in mid-2019 for Medicare Advantage.Oct patients. 1, 2018 – UPMC announces that after the impending split, patients insured at Hautemark are subject to a prepayment rule in most UPMC facilities. Highmark is asking UPMC to reconsider this issue. Helplines are flooded with thousands of calls from frustrated and disoriented seniors. November 2018 , Highmark agrees to new conditions to extend access to the network with UPMC, as requested by the Attorney General.