State Launches Website to Help Consumers with Dec. 31 Termination of UPMC/Highmark Contract

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Consumers who use Highmark or UPMC for their health care services may see changes when the contract between the two expires Dec. 31, 2014.

Patients may have questions such as “What does it mean for me,” “How will it impact my access to care?,” Can I keep my doctor?,” and “Will I have to pay more for services?”

Information and guidance is now available on a new website designed to help consumers navigate the changes at www.stayinformed.pa.gov. Downloadable fact sheets include:

  • Glossary of Terms
  • Things You Need to Know   — Includes a list of the protections put into place for UPMC and Highmark consumers and patients through agreements reached this past summer
  • Questions to Ask When Selecting a Health Plan
  • Resources available through state agencies and elsewhere

The website was developed by the Pennsylvania Insurance Department and the Pennsylvania Department of Health.

Physicians may get questions as consumers have been encouraged to talk to their physician and health insurance company about these changes.

A letter to the community will appear in the Pittsburgh-area newspapers describing the types of questions some consumers have, the safeguards put in place to protect consumers, and resources consumers can access.

Patients may have questions about their rights. It’s important to tell them that key safeguards include that:

  • In the case of a medical emergency, they can go to any Emergency Room for immediate care, regardless of their insurance provider. In the case of Highmark subscribers receiving care from UPMC providers, the emergency treatment will be covered on an in-network basis according to the terms of their specific health insurance plan, including hospital, physician, and other health care services related to the emergency condition, consistent with their coverage terms.
  • Medicaid and CHIP enrollees have in-network access to all UPMC providers.
  • Cancer patients won’t be denied access to UPMC cancer facilities.
  • Patients in the middle of a course of treatment, in consultation with a treating UPMC physician, will be able to continue seeing that physician.

Patients also may have specific questions about access. Access to select hospitals has been preserved. Highmark subscribers may continue to go to the following hospitals as if they’re in-network:

    • Children’s Hospital of Pittsburgh of UPMC (through 2022)
    • UPMC Altoona
    • UPMC Bedford Memorial
    • UPMC Hamot and Kane Community Hospital
    • UPMC Horizon
    • UPMC Mercy (until June 2015)
    • UPMC Northwest
    • Western Psychiatric Institute and Clinic of UPMC

Patients should always confirm that their provider and the facility where they receive care is in their health care plan’s network.

And, patients may have questions that the state would be better able to answer. The Pennsylvania Insurance Department is available to help consumers understand the agreements and how the change that is coming may affect them, offer questions to consider when choosing health insurance, and assist consumers with filing complaints. They can be reached at 1-877-881-6388 or by email at ra-in-stayinformed@pa.gov.

The Pennsylvania Department of Health, Bureau of Managed Care, is available to assist consumers with continuing care concerns, discuss local provider access when a UPMC provider is the only available provider in the area for a particular service, and answer questions regarding access to Children’s Hospital, Western Psychiatric Institute and Clinic of UPMC, and UPMC hospitals outside of Allegheny County and its adjacent counties. They can be reached at (717) 787-5193 or via email at RA-DHWPATRANQST@pa.gov.

Questions about health insurance benefits or access to a specific provider/facility or continuing of care for an ongoing medical condition should be directed to Highmark or UPMC and/or the patient’s provider.

The Allegheny County Medical Society and the Hospital Council of Western PA held a leadership meeting on Dec. 10, with Secretary of Health Michael Wolf as the guest speaker, to talk about the UPMC/Highmark transition.

PAMED is in the process of reviewing legislation that would provide for binding arbitration when insurers and hospital systems cannot agree on contract terms.