Archive

ShareThis Page
Highmark and UPMC feud over canceled physician contracts | TribLIVE.com
Local Stories

Highmark and UPMC feud over canceled physician contracts

Highmark Inc. said Thursday it terminated contracts with 689 UPMC physicians in the Pittsburgh region to make clear that the doctors would be out-of-network for the insurer’s subscribers on Jan. 1.

UPMC called Highmark’s move an “illegal breach” of the contracts and said the state’s largest health insurer has “no legal right” to selectively terminate physician agreements.

Consent decrees negotiated with Gov. Tom Corbett and Attorney General Kathleen Kane this summer were meant to provide for an orderly breakup between the health giants and calm an escalating three-year war for customers in Western Pennsylvania, but the battle continued Thursday over the contract terminations.

“This is simply the next step by an increasingly desperate Highmark to exclude all UPMC physicians from all products they offer,” UPMC spokesman Paul Wood said.

He declined to comment on what action the region’s biggest hospital system would take. The consent decrees call for binding arbitration to settle disputes.

Highmark ended the contracts because UPMC refused to do so, said Tom Fitzpatrick, Highmark’s senior vice president of provider contracting.

If the contracts had remained in place, Highmark would have had to list the UPMC physicians as in-network in its directories and on its website. Under the terms of the consent decrees, about 20 percent of UPMC’s physicians will be out-of-network on Jan. 1.

“We needed to ensure that our members would be clear when they make determinations of which doctors are in and which doctors are out,” Fitzpatrick said.

Under the consent decrees, Highmark members have limited access to some UPMC facilities and physicians. For instance, all UPMC hospitals outside the Pittsburgh region, such as those in Altoona, Bedford and other rural areas, and specialty hospitals such as Children’s and Western Psychiatric Institute and Clinic, are in-network.

And UPMC doctors who have admitting privileges at independent community hospitals can see Highmark members at those facilities, such as St. Clair Hospital in Mt. Lebanon or Heritage Valley Health System hospitals in Sewickley and Beaver.

The 689 UPMC doctors whose contracts Highmark terminated only practice in the Pittsburgh region, Fitzpatrick said.

UPMC and Highmark have been fighting since 2011, when Highmark announced it would buy West Penn Allegheny Health System and convert into an integrated health system with both insurance and hospital operations. UPMC responded by saying it would not renew reimbursement contracts that give Highmark members in-network access to UPMC hospitals and doctors.

A 2012 agreement between Highmark and UPMC, also negotiated by Corbett, called for their contracts to expire at the end of this year.

Public outcry over the potential loss of affordable access to unique UPMC medical services led officials to negotiate the consent decrees.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or [email protected].


TribLIVE commenting policy

You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.

We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.

While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.

We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers

We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.

We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.

We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.

We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.