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Last-minute legalities hold up Highmark transition agreement

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By Alex Nixon and Brad Bumsted
Friday, June 27, 2014, 6:57 a.m.
 

Last-minute legal wrangling delayed a plan for what will happen to Highmark Inc. members when the insurer's contract with UPMC ends.

Gov. Tom Corbett, who has been negotiating the plan with Attorney General Kathleen Kane and the two Pittsburgh health care companies, responded to inquiries about the delay from reporters on Thursday by stating, “You know — lawyers. ... As soon as we can announce something, we will.”

The governor declined to elaborate. Kane spokesman J.J. Abbott declined to comment.

Later in the day, Corbett and Kane said they “continue to work together to reach an agreement that puts patients first,” according to a written statement. “Our collective hope is that both Highmark and UPMC can come together with the best interests of the region in mind.”

Officials with UPMC and Highmark declined to comment.

Sources told the Tribune-Review that the transition plan, which executives from Highmark and UPMC had agreed to earlier this week, did not appear to be in danger of unraveling. The legal wrangling was described as minor.

The transition plan is a product of negotiations led by Corbett's Patients First Leadership Team.

Corbett, a Republican, and Kane, a Democrat, scrapped a news conference planned for Wednesday to iron out final details.

“I think there has been some dispute arising among members of the Patients First task force,” said Senate Minority Leader Jay Costa, D-Forest Hills.

The transition plan would benefit a limited number of Highmark subscribers. The state's largest health insurer has more than 4 million members in Pennsylvania.

The plan allows seriously ill Highmark members under the treatment of UPMC doctors to receive care for a limited time when a reimbursement contract between the feuding companies expires at the end of the year.

It provides Highmark members continued access to UPMC hospitals in rural areas outside of Pittsburgh, but makes all UPMC hospitals and doctors in Allegheny, Beaver, Butler, Washington and Westmoreland counties out-of-network. There are two exceptions: specialty medical centers Children's Hospital of Pittsburgh and Western Psychiatric Institute and Clinic.

UPMC has the biggest network of hospitals and doctors in Western Pennsylvania.

The plan makes clear that Medicare and Medicaid recipients will continue to have in-network access to all UPMC hospitals and doctors, and opens most of UPMC's cancer services to Highmark members, as long as the insurer approves the treatments.

Highmark patients under the care of UPMC doctors for serious illness or pregnancy will be allowed to continue their course of treatment until they can be transferred to a comparable service at a non-UPMC hospital.

The deal on a transition plan, which states that it should not be characterized as a contract extension, is not what Highmark, its patients and some lawmakers had been advocating for during the past several years.

Highmark has maintained that UPMC should have to contract with all willing health insurers. But UPMC has argued since Highmark purchased the West Penn Allegheny Health System that it can't be forced to have a business relationship with a direct competitor.

Agreeing to the transition plan doesn't mean that Highmark leaders will abandon their fight for a full-access contract with UPMC, said James McTiernan, a health care consultant with Triad Gallagher, a Downtown benefits firm.

“These transition plans had to be made. Whether or not they're necessary, time will tell,” he said.

“They had to be prepared to help their members that need to transition,” he said. “They've said all along, and I believe them, that they want this to work out, and I think they'll continue to try.”

Alex Nixon and Brad Bumsted are staff writers for Trib Total Media. Nixon can be reached at 412-320-7928 or anixon@tribweb.com. Bumsted can be reached at 717-787-1405 or bbumsted@tribweb.com.

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