Highmark and the University of Pittsburgh Medical Center reached an agreement , ending their months-long impasse over health coverage for people in Western Pennsylvania through December 2014.
The deal forged by the two companies, aided by a mediator, ensures in-network access to all UPMC hospitals and physicians for Highmark commercial and Medicare Advantage members. Highmark, the state’s largest health insurer, serves Western and Central Pennsylvania.
“Both UPMC and Highmark worked diligently toward this amicable resolution for the benefit of UPMC patients, Highmark subscribers and the millions of citizens impacted by the uncertainty of their dispute,” said Pennsylvania Gov. Tom Corbett in announcing the deal. “I, along with the citizens of western Pennsylvania, am pleased with this outcome.”
Corbett appointed a mediator, David F. Simon, executive vice president and chief legal officer of Jefferson Health System in Southeastern Pennsylvania, who worked with the parties over the last few weeks.
“David’s expertise in insurance and health system finance was vital. Having a neutral third party was essential and I appreciate David’s effort on this important matter,” Corbett said.
Corbett said, recognizing special community needs, Highmark and UPMC will be negotiating access to “unique UPMC services” beginning in 2015, including Western Psychiatric Institute, certain oncological services and community hospitals.
Current agreements stay in place for UPMC Children’s Hospital. For 2015, the parties will also negotiate continued coverage and services for vulnerable populations, including those enrolled in the Children’s Health Insurance Program (CHIP), Special Care and PA Fair Care, Pennsylvania’s plan for persons with pre-existing conditions.
“What this agreement means is that medical insurance protection will continue for our state’s most vulnerable citizens, including those that rely on Pennsylvania’s health care plans for their children and other family members,” Corbett said.
Corbett said contributions from several members of the Pennsylvania General Assembly for their involvement in this matter, including Sen. Donald C. White (R-Armstrong) and Sen. Jay Costa (D-Allegheny), as well as Rep. Mike Turzai (R-Allegheny), Rep. Frank Dermody (D-Allegheny) and Rep. Randy Vulakovich (R-Allegheny), contributed to the resolution of the impasse.