UPMC-Highmark battle expands to any Blue Cross Blue Shield subscriber
Highmark Inc. insurance subscribers are not the only ones who will pay higher out-of-network rates to UPMC hospitals and doctors next year.
Anyone with health insurance through a Blue Cross Blue Shield company in America, including more than a quarter-million people in Western Pennsylvania, will be out of network in 2015 when Highmark's reimbursement contract with UPMC expires.
The nation's 37 other Blue Cross companies are covered locally through Highmark's network of hospitals and doctors, which includes UPMC, according to Highmark spokesman Aaron Billger.
Known as the Blue Card program, the arrangement allows Blue Cross companies to offer broad national networks of medical providers for their plan members without having to contract individually with hospitals and doctors outside their service areas.
The situation affects local employees of companies such as US Airways, which is based outside Pittsburgh and provides health insurance through Anthem Blue Cross Blue Shield. Its 600 workers in Moon will need a different insurer if they want to keep in-network access to UPMC.
“That's not good,” said Dan Persuit, president of the Transport Workers Union Local 545 that represents more than 160 US Airways dispatchers. Persuit said he had been under the impression that he and his colleagues were insulated from the UPMC-Highmark contract battle because their insurer is Anthem.
American Airlines spokesman Todd Lehmacher declined to comment on the situation.
US Airways recently was acquired by Dallas-based American Airlines, which said it plans to close the Moon operations center in about 18 months.
Billger said there are 275,000 Western Pennsylvanians with health insurance through a Blue Cross Blue Shield plan that uses Highmark's provider network. That's in addition to more than 3 million members Highmark has in the region.
“UPMC would be turning away affordable access for hundreds of thousands of people living in our region who have a Blue health insurance program from an employer based outside of our region,” Billger said. “If there is no contract, these people would not have affordable in-network access to UPMC facilities.”
UPMC, which refuses to negotiate a contract renewal with Highmark because the state's largest insurer bought rival hospital network West Penn Allegheny Health System, would prefer to keep non-Highmark Blue Cross customers, spokesman Paul Wood said.
But Blue Cross companies are not allowed to contract directly with hospitals and doctors outside their territories, he said.
“UPMC would be happy to contract for in-network access directly with any Blue Cross company nationwide that does not operate a hospital system in competition with UPMC,” Wood said.
UPMC, which owns 20 hospitals and employs about 3,500 doctors, is the largest health system in Western Pennsylvania. When the contract ends, most hospitals will be out-of-network for Blue Cross members, except specialty hospitals such as Children's Hospital and Pittsburgh and Western Psychiatric Institute and Clinic.
At least four Pittsburgh Business Group on Health member companies are in the same situation as US Airways, said Jessica Brooks, executive director of the group. They are based outside Western Pennsylvania and provide health insurance to employees in Pittsburgh and locations across the country through a non-Highmark Blue Cross company, said Brooks.
She declined to name the companies.
“They're faced with the challenge (of) trying to figure out how to best serve all their employees,” Brooks said.
If they want Pittsburgh employees to maintain in-network access to UPMC, they will have to change their national plan or offer a separate insurance option to employees here.
“It's definitely a high priority” for those employers, she said. “Access to provider networks is high on the list” for workers.
Alex Nixon is a Trib Total Media staff writer. Reach him at 412-320-7928 or firstname.lastname@example.org.