Highmark

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After stating last month that it would not accept Highmark Medicare patients due to Highmark's cancer treatment "mark-ups," UPMC has been ordered by Commonwealth Court Judge Dan Pelligrini to continue to see the 182,000 seniors they currently serve through Highmark. UPMC has already vowed to appeal the court order under a scheduled arbitration to resolve the differences between the two providers. Pittsburgh Business Times health care reporter Kris Mamula joins us in studio. (starts at 15:13) 

Mamula explains Pelligrini's ambitious hopes for the on-going dispute between UPMC and Highmark: 

"He wants all of the contractual issues between Highmark and UPMC resolved by September 30th, which is an ambitious deadline given everything that has happened. ... He wants those things that divide them to be resolved." -Kris Mamula

Also, Acting State Police Commissioner Marcus Brown fielded questions from state Senators at his nomination hearing. Emily Prevetti has the details. And we'll preview this year's Three Rivers Arts Festival with director Veronica Corpuz, and finally, Elaine Labalme has special travel plans to help celebrate dad. 

Highmark has agreed to pay the approximately 30,000 outstanding medical claims filed by UPMC providers and facilities since January 1.

Gov. Tom Wolf called it a “major win” for patients. 

“My focus is protecting consumers caught in the dispute between Highmark and UPMC, and I have urged both companies to do the same,” Wolf said.

The state of Pennsylvania has filed a motion in Commonwealth Court that would force UPMC and Highmark to enter into arbitration to settle a dispute that could force some 180,000 Medicare Advantage recipients to look for new doctors or new coverage options.

The University of Pittsburgh Medical Center is threatening to terminate its Medicare contract with rival Highmark, which could cause about 180,000 seniors in western Pennsylvania to lose in-network access to UPMC hospitals and doctors next year.

UPMC says Highmark has refused to pay contracted rates for cancer treatment at the Hillman Cancer Center in Shadyside.

Spokesman Paul Wood said Highmark owes UPMC about $143 million.

Michael Lynch / 90.5 WESA

After nearly two years of development and delays, Pittsburgh’s bike share program is finally ready to roll.

Through “Healthy Ride,” 500 bikes will be placed at 50 stations around the city, including downtown, the North Side, South Side, Oakland and the East End.

Gov. Tom Wolf and his administration want to assure healthcare consumers that they intend to enforce the consent decrees signed by Highmark and UPMC in June 2014.

According to the administration, both of the healthcare providers have made statements that have led to confusion.

Teresa Miller, the Acting Insurance Commissioner, as well as Karen Murphy, the Acting Health Secretary, announced that they will make sure patients with Highmark plans are able to receive care from UPMC providers as outlined  in the decrees.

The Northside Leadership Conference will use $900,000 in pledged funding from Highmark, Northwest Savings Bank and the Pittsburgh Steelers to support the North Side neighborhood including small business and strategic real estate development.

Gloria Rayman, past NSLC board of directors president, said Friday because the coalition of grassroots neighborhood organizations has non-profit status, it can partner with corporate sponsors.

Tom Wolf / Flickr

Carnegie Mellon University Health Law professor Gary Kaplan joins us to talk about how Pennsylvania’s implementation of the Affordable Care Act could change under the Wolf administration.

Professor Kaplan represents private employers in advising them on health care plan options. So what do employers need to know about the UPMC and Highmark contract in 2015?

Kaplan explains that Wolf is interested in going with a different plan for the implementation of the Medicaid expansion than what Tom Corbett had planned. 

The state is launching a website to help consumers through the impending termination of a contract between a Western Pennsylvania insurer and the region's dominant hospital and outpatient network.

Officials said they're posting information to stayInformed.pa.gov about changes taking effect Jan. 1 when most Highmark subscribers lose in-network access to UPMC doctors and hospitals. This change has raised many questions, and they have been fielded through the PA Department of Insurance.

Highmark Unveils Healthcare Center in Wexford

Sep 23, 2014
Julian Routh / 90.5 WESA

Rather than having to go from doctor to doctor for health care, Highmark patients will soon be able to get the care they need all under one roof.

Officials from Highmark Health and the Allegheny Health Network unveiled the new Health + Wellness Pavilion in Wexford Tuesday afternoon, less than two weeks before its opening to the public.

The 175,000 square foot facility, deemed a "medical mall," will house an array of retail, diagnostic, preventive and therapeutic healthcare services.

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.

UPMC and Highmark, A Confusing Truce

Jul 1, 2014
Life Mental Health / Flickr

The announcement of a five-year consent decree brokered by state officials seems to be bringing a truce between Highmark and UPMC. What exactly will the agreement mean for policy holders? State Insurance Commissioner Michael Consedine highlights some of the major aspects of the decree to policyholders who may be experiencing some confusion with these “out of network” hospitals.

Some of UPMC’s most prominent hospitals are not in the network, included Magee Women’s Hospital. Commissioner Consedine says the largest issues surrounding the agreement are not which specialty hospitals will remain open in the network, but rather contingency of those already being treated by UPMC doctors, oncology care, and emergency services.

Gov. Tom Corbett is calling on UPMC and Highmark to put their patients first.

The contract between UPMC and Highmark is set to expire by December 31st, 2014.

UPMC said that it does not intend to extend the contract, which means that Highmark patients will not receive in-network rates for UPMC services.

Flickr user Via Tsuji

With high temperatures in the 90s this week, it’s hard to believe Pittsburgh saw snow less than two months ago.

Thankfully, the Steel City has finally shrugged off winter just in time for a slew of outdoor events in and around downtown Pittsburgh.

Venture Outdoors Festival

Point State Park is the location for the 14th annual Venture Outdoors Festival, which takes place at Point State Park and runs from 11 a.m. to 6 p.m. on Saturday.

Allegheny County employees no longer have to wonder about their health care options for 2015.

Allegheny County Executive Rich Fitzgerald announced Tuesday that the county will exclusively retain Highmark for health care coverage through December 31st, 2015 - even if Highmark and UPMC are unable to reach an agreement.

At the end of next year, the contract between the University of Pittsburgh Medical Center and Highmark Health Plan will expire, and many Western Pennsylvanians are worried about losing access to the doctors and hospitals they have patronized for years.

In October, a pair of Pennsylvania House representatives introduced legislation that would impose new rules on nonprofit integrated delivery networks, like UPMC, which offer both healthcare and health insurance.

After more than three years without a hospital, Braddock is set to get another medical facility.

On Friday, ground was broken on a new commercial development that will include a Highmark and Allegheny Health Network full service urgent care center, to serve the more than 2,100 people who live in the borough.

“They’ll have access to health care services as well as good, positive development on the main drag of Braddock,” said Allegheny County Executive Rich Fitzgerald.

UPMC Braddock closed its doors in early 2010.

Confusion continues to swirl around the coming split of Highmark and UPMC, and a pair of western Pennsylvania state representatives is hoping to calm the fears of many in the region.

Reps. Jim Christiana (R-Beaver) and Dan Frankel (D-Allegheny) this week introduced a pair of bills (HB 1621 and HB 1622) that would force all not-for-profit health care insurers and health care providers to open their services to all insurance holders, not just their own.

West Penn Allegheny hospitals laid off 262 employees Friday, and another 200 vacant positions are being eliminated.

“This action is extremely difficult but is an essential step in our efforts to right-size the organization for the patient volume that we currently have and to strongly position it for future growth and success as a leading healthcare provider in this region,” said Dan Laurent, a spokesman for Highmark’s Allegheny Health Network.

West Penn Allegheny will now have 10,300 employees and the Allegheny Health Network as a whole, 17,000.

A new insurance plan from Highmark allows employers to nudge their employees toward particular hospitals when they need risky surgeries.

Employers using the "Blue Distinction" program can give incentives, such as waived deductibles and co-pays, to employees who choose hospitals that have proven track records for certain surgeries.

The company can also choose to increase co-pays or even “carve out” coverage for any other hospital when the specialty surgery is needed, according to Highmark Vice President of Regional Sales Eric Hays.