UPMC: Highmark patients won't lose access to Children's Hospital of Pittsburgh

UPMC has no intention to sever access to Highmark-insured patients seeking care at UPMC Children’s Hospital of Pittsburgh nor impose a prepay rule on any patients who are treated there, regardless of their insurance cards, UPMC Chief Financial Officer Robert DeMichiei said Thursday.

“There’s never been any indication of any intention on our part, none, to ever deny access (to Children’s Hospital) to anyone, any insurance,” DeMichiei said.

As for Highmark insurance plans and Children’s Hospital, “We will welcome an ongoing relationship,” DiMichiei said.

Highmark’s current contract with Children’s Hospital expires in 2022.

Leaders of both UPMC and Highmark — Pittsburgh-based rivals that each control both insurer and provider arms — say they are optimistic that they will negotiate a new provider-insurer contract before the existing one expires.

But each nonprofit health giant also blames the other for not inking such a deal already.

“We have opened up to have a discussion around an extension (with Highmark),” DiMichiei said, “and we have not gotten a response.”

That claim is “not true,” as Highmark has made several such attempts and presented proposals to Children’s Hospital officials, including its former president, Chris Gessner, according to Highmark spokeswoman Lynn Seay.

“In every attempt, UPMC has either refused to accept our proposal or to offer a counter-proposal,” Seay said. “We stand ready to negotiate a fair and reasonable contract with UPMC Children’s.”

Broader feud continues

DiMichiei’s reassurance that Western Pennsylvanians will retain access to Children’s Hospital comes as a broader feud and fight for market domination between the two health care giants rages on.

Thousands of seniors, people with disabilities and cancer patients are set to become out-of-network and be subject to a controversial prepay-in-full rule at most UPMC hospitals staring July 1.

Children’s Hospital is excluded from the 2019 split, as are UPMC hospitals in rural areas or cancer centers where there are no alternatives.

State Attorney General Josh Shapiro seeks to halt the looming June 30 breakup to preserve access for Medicare Advantage and cancer patients.

In a legal filing related to Shapiro’s case on Wednesday, UPMC’s attorneys blamed Highmark for the lag in a contract extension with Children’s Hospital. They pointed out Highmark and UPMC already have extended a contract for Western Psychiatric hospital through 2024.

“While Highmark agreed during a 2018 mediation led by the Governor and Pennsylvania Insurance Department to extend the UPMC Western Psychiatric contract, it has thus far singularly refused to extend the UPMC Children’s Hospital contract as it grows its own pediatric services,” UPMC’s attorneys wrote in the state Supreme Court filing.

A showdown between Shapiro and UPMC looms before Supreme Court justices on May 16 to decide whether the June 30 expiration can be extended for Medicare Advantage patients and other types of patients set to be impacted by the split this summer.

Ultimately, Shapiro hopes to extend in-network access indefinitely to patients with Highmark or any other insurer willing to contract with UPMC.

Highmark supports Shapiro’s efforts. Shapiro’s actions “affirm what we have been seeking for the past five years — a level playing field that fosters healthy competition” and increased affordability and access for consumers, Seay said.