Highmark-UPMC Transition Plan Now Publicly Available

Sep 2, 2014

The Pennsylvania Insurance Department Tuesday announced it has received and publicly posted the final transition plan for consumers affected by the separation of Highmark and UPMC at the end of 2014.

“We’re excited, because now we can bring clarity to the transition plan, we can help members make choices they need to make, and we think it’s an important part of the roadmap for us as we move forward,” said Deborah Rice Johnson, president of Highmark Health Plan.

The transition agreement reached in June provides some flexibility for patients with Highmark insurance and UPMC doctors. In some cases, patients may be able to continue to see UPMC doctors past the end of this year. Community hospitals outside the Pittsburgh area will be available to Highmark insurance costumers at higher, out-of-network rates. Emergency and trauma services at UPMC hospitals will still be available at in-network rates.

Johnson said Highmark and UPMC are committed to “assuring that there is not disruption, assuring that our members have access to the care they need, and assuring that they can continue to see care where necessary. At times that’s with UPMC, and the consent decree provides those important protections.”

State insurance commissioner Mike Consedine said the announcement has been a long time coming.

“The filing of the transition plan actually goes back to our approval of Highmark’s affiliation with the West Penn Hospital system,” Consedine said. “We knew almost a year and a half ago that we’d likely be looking at a scenario where … Highmark and UPMC would be separating.”

The commissioner said the plan will continue to be refined as the transition is implemented, and that additional resources will be posted on the specially dedicated website, stayinformed.pa.gov, as they become available.

Johnson said Highmark staff will also be available to assist customers during the transition.

“We know this whole process, for the Western Pennsylvania community, has been very disruptive, very frustrating at times,” Consedine said. “Our whole goal here is to start to reduce that confusion, reduce that angst, and bring more clarity to these very important issues.”