Customers anxious for details about Highmark transition plan for W. Pa.
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 email@example.com.
Add Alex Nixon to your Google+ circles.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- LNG exports get federal approval from Dominion’s Cove Point terminal
- Cranberry-based Prodigo Solutions: Hospitals can reduce high supply costs
- With acquisition, PNC set to enter IPO market
- Western Pa. unemployment rate holds steady in August
- NHTSA probes sudden acceleration complaints in Toyota Corollas
- Consumer spending climbs as job gains boost incomes
- Hospitals turn to technology to tear down language barriers with patients