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Customers anxious for details about Highmark transition plan for W. Pa.

The end of a contract between Highmark Inc. and UPMC spells uncertainty for the company's insurance subscribers. File photo

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Wednesday, Aug. 27, 2014, 11:15 p.m.
 

Highmark Inc. and insurance regulators are still hashing out some details of state-mandated transition plan the health insurer filed a month ago that details what will happen to its insurance subscribers when a contract ends with medical provider UPMC.

The Pittsburgh Business Group on Health, an organization that represents about 90 large employers in Pittsburgh, criticized the apparent delay and said it is adding to uncertainty for companies that need to make decisions about their employee health insurance coverage.

The transition plan is the culmination of consent decrees between UPMC and Highmark, negotiated in June with the help of Gov. Tom Corbett and Attorney General Kathleen Kane.

The “draft” transition plan filed by Highmark on July 31 “has evolved as part of our review to ensure maximum clarity,” said Rosanne Placey, a spokeswoman for the state Department of Insurance. She's unable to provide a timeline for public release of the plan.

“With all the confusion in Western PA, it would not be helpful to offer something that might create even further confusion,” Placey said.

As days and weeks tick by toward the end of the year and the contract expiration, hundreds of thousands of Highmark members in Western Pennsylvania and the region's biggest employers are uncertain about what parts of UPMC will remain in-network on Jan. 1.

“The ongoing delay relative to the Highmark-UPMC transition plan is another indication of the lack of clarity resulting from the recent consent decree,” said Jessica Brooks, executive director of the Pittsburgh Business Group on Health. “Any further delay compounds the ability of employers to make the best informed decisions with their employees' health care needs.”

Spokespeople for Corbett and Kane declined to comment, and referred questions to the Department of Insurance. Neither Placey nor Highmark spokesman Aaron Billger would provide specifics about what was holding up the approval.

“Because Highmark customers and the community are at the center of this plan, we are working with the Insurance Department to ensure the plan provides the utmost clarity to health care consumers,” Billger said.

UPMC, the region's largest hospital system, is not a part of discussions over the plan, spokesman Paul Wood said.

Corbett, a Republican, and Kane, a Democrat, waded into the long-running battle between UPMC and Highmark. The politicians negotiated the five-year consent decrees signed by UPMC and Highmark that protect patients from losing access to critical health care providers and facilities.

UPMC has said since 2011, when Highmark announced it would buy West Penn Allegheny Health System and establish a competing hospital network, that it would not renew a contract. Without a contract, Highmark members would have to pay costly out-of-network charges to access UPMC's hospitals and doctors.

But many details of the decrees remain unclear.

For example, they state that Highmark members “in the midst of a course of treatment at UPMC” would be charged in-network rates. But an exact definition of “course of treatment” or what treatments would qualify have not been explained.

The plan is expected to clarify exactly which UPMC doctors will be in-network for Highmark members. UPMC has disputed Highmark's contention that a majority of UPMC physicians will be in-network because they either practice at a specialty hospital or community hospital that will remain in-network for Highmark members.

“There are many more questions employers from across our region are hoping will be answered by the transition plan,” the business group's Brooks said.

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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