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Geisinger bashes Highmark plan

| Thursday, Aug. 22, 2013, 12:01 a.m.

UPMC isn't the only hospital network running ads critical of the state's largest health insurer.

Danville-based Geisinger Health System has taken to newspapers in central Pennsylvania denouncing Highmark Health Services over a health plan it introduced this year that makes insurance customers pay more for treatment at Geisinger hospitals than at hospitals Highmark deems lower cost.

In a print ad, Geisinger CEO Glenn Steele Jr. accuses Highmark of forcing patients to seek treatment outside their communities by charging them more to access Geisinger's three hospitals and physician group.

“It's inappropriate, inconvenient, insensitive and simply wrong to force our neighbors to leave home to seek the care they desperately need,” Steele writes in the ad. “It's bad for you and your family. And it's bad for central Pennsylvania.”

Highmark spokesman Leilyn Perri said the central Pennsylvania product, Community Blue Premier Flex, doesn't prevent patients from going to the hospital of their choice.

“We're trying to give customers options,” Perri said. “We want to try to tell our customers there are some facilities that are more expensive than others.”

Geisinger officials could not be reached for comment.

UPMC spokesman Paul Wood said Geisinger's experience with Highmark illustrates why UPMC, the largest hospital network in Western Pennsylvania, won't renew its Highmark reimbursement contract, which expires at the end of 2014.

“This is exactly what Highmark would do to UPMC if there were a contract, which is precisely why there cannot be a contract,” Wood said.

UPMC has mounted a television advertising blitz in Western Pennsylvania in which it argues that a new contract would give Highmark the ability to prevent its members from accessing UPMC.

Wood said Highmark would put UPMC in a higher-cost tier in order to steer 41,000 UPMC patients to the seven Allegheny Health Network hospitals owned by Highmark. The current UPMC-Highmark contract forbids tiering, he said.

Highmark defended its strategy of highlighting more expensive medical facilities as a way to better control runaway health costs.

“If they could lower their cost, they could get into a better tier,” spokeswoman Kristin Ash said.

Premier Flex, which began in nine central Pennsylvania counties July 1 and will expand to 11 more on Jan. 1, puts hospitals and doctors into three tiers based on cost — enhanced, standard and out-of-network. Members have lower copays and other out-of-pocket costs in the enhanced tier, higher payments in the standard tier, and even larger costs if the hospital is out-of-network.

Geisinger hospitals, and those of three other systems, are in the standard tier because they are more expensive than other hospitals in the region, Perri said.

Highmark has about 1 million members in the 21-county region where Premier Flex will be sold. Perri declined to say how many customers have signed up so far in the first nine counties, but said it's “not significant.”

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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