UPMC And Highmark Insurance Reach New Five-Year Agreement To Provide In-Network Rates

Jan 4, 2018

Highmark health insurance has reached a five-year agreement with UPMC to allow its customers to receive care from select UPMC locations at in-network rates.

The agreement applies to some facilities that offer highly specialized services in oncology, transplants and other fields. It also includes hospitals in communities where UPMC owns the only facility, such as in Altoona, Bedford and Lancaster.

“Had this agreement not been signed these are hospitals would have otherwise been considered out-of-network,” said Tom Fitzpatrick, Highmark’s senior vice president of provider contracting, relations and partnerships.

In 2012, UPMC announced it would no longer serve Highmark customers at in-network rates. Amid patient concern, the state stepped in to broker a consent decree in 2014. That decree expires in June 2019, when the new agreement takes effect.

Acting Insurance Commissioner Jessica Altman said she’s happy with the contract reached between Highmark and UPMC.

“There’s no doubt this has been a contentious relationship over the years,” said Altman. “But you know competition is also good, and it generally serves consumers well. It’s just in these cases where there is no competition because there’s only one choice, at least as it stands, so we really need to have access.”

UPMC specialty facilities that will continue to accept Highmark insurance include Western Psychiatric Institute, UPMC Center for Assistive Technology and the UPMC Center for Excellence for treatment of Cystic Fibrosis. Under a different agreement, Children’s Hospital of Pittsburgh also accepts Highmark.

(Photo credit: Crazypaco/Wikimedia)