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HealthAmerica announces UPMC contract

| Monday, June 20, 2011

HealthAmerica today announced it is adding UPMC's Presbyterian and Shadyside hospitals to the list of health-care facilities the national insurer offers its customers.

With the latest contract, which takes effect July 1, HealthAmerica's commercial group and individual plan members in Western Pennsylvania will have in-network access to UPMC Presbyterian and UPMC Shadyside and all UPMC's affiliated physicians for the first time in the insurer's 36-year history. The firm already had in place agreements that allow its members access to other UPMC facilities.

"Our expanded relationship with UPMC gives our customers in western Pennsylvania greater access to more high-quality medical facilities and skilled physicians closer to where they live and work," Jerome D. Dioguardi, vice president, network development, HealthAmerica, said in a statement.

HealthAmerica, based in Harrisburg and with an office in Pittsburgh, is owned by Coventry Corp., the fifth largest insurer in the state. HealthAmerica has 470,000 members in its insurance plans in Pennsylvania and Ohio.

UPMC previously announced contracts with three other national insurers: Aetna, United HealthCare and Cigna. With the UPMC Health Plan, those national insurers will be offering access to UPMC hospitals and doctors.

But Highmark, the largest insurer in the Pittsburgh market with 3 million members, has not reached an agreement with UPMC to extend its contracts.

A Highmark contract for UPMC hospitals -- except Mercy and Children's -- expires June 30, 2012. Highmark members will be able to access health-care facilities for up to another year, but under the terms of the deal will need prior approval and might have to pay more.

UPMC also is canceling a contract for most of its doctors with Highmark, effective the same day. After that, Highmark members will have to pay out-of-network provider rates to most UPMC physicians.

Aetna, which is the second-largest insurer in Philadelphia, plans to increase its profile in Pittsburgh and will be reaching out to brokers and agents who deal with mid-sized and small employers, said spokesman Walt Cherniak Jr. The company also plans to add sales staff in Western Pennsylvania, he said.

"With the UPMC contract, we have expanded opportunities to grow membership," Cherniak said today. "We're currently looking at strategies to increase our visibility there."

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