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Highmark to Limit Access to UPMC for Medicare

Insurance No Longer “Accepted Everywhere”

PITTSBURGH, Feb. 21 – Highmark has notified UPMC that Highmark’s Medicare subscribers will not have in-network access to UPMC East when that state-of-the-art facility opens in Monroeville in July 2012, despite previously announcing otherwise to its subscribers. UPMC offered Highmark Medicare contracts to UPMC East identical to those that are in place with UPMC’s other facilities, but Highmark declined.

In December, Highmark assured all of its Medicare, Medicare Advantage, Medicaid, and Children’s Health Insurance Plan (CHIP) subscribers and patients “that their in-network access to UPMC hospitals and physicians willnot be affected by the upcoming changes in the contractual relationships between Highmark and UPMC.” Despite these assurances, which were made at the request of Pennsylvania Senators Don White and Jay Costa, Highmark has decided that its subscribers will not have in-network access to UPMC East.

“Highmark’s decision is unfortunate for its Medicare subscribers, but entirely predictable,” said Paul Wood, Vice President, Public Relations, UPMC. “Now that Highmark is acquiring Forbes as part of its $475 million take-over of the struggling West Penn Allegheny Health System, it obviously feels it has to steer patients there rather than allowing them to choose UPMC facilities.”

Highmark also has committed an additional $500 million to outpatient facilities and medical malls, and has purchased the Premier Medical Associates physician group as well as an interest in MedExpress. These investments, according to Highmark, are to compete with UPMC, their “chief rival” in health care. As such, Highmark has decided to limit access to UPMC facilities immediately.

UPMC East is a 156-bed full-service community hospital built to meet the growing demand for world-class care in the eastern suburbs. UPMC East will provide patient-centered clinical care and amenities with the latest technology and environmentally efficient design and construction. The hospital is synergistic with an array of outpatient healthcare services already provided by UPMC in Monroeville, including primary care and specialty physicians, advanced diagnostic services and outpatient surgery. UPMC East is expected to create more than 400 new jobs upon its opening.

“Highmark clearly is concerned that if it gives Medicare subscribers the choice to access UPMC East, then patients will choose UPMC East,” added Wood. “It would not surprise UPMC, given the reopening of West Penn Hospital in Bloomfield, for Highmark to deny its Medicare subscribers’ access to the nearby UPMC Shadyside and other nearby facilities.”

“It is such conflicts of interests and monopolistic behavior by Highmark that caused the federal Centers for Medicare & Medicaid Services (CMS) to force Highmark to sell its Medicare claims processing business and the Department of Justice to initiate a federal antitrust investigation,” according to Wood. “Highmark must protect what will become a multibillion-dollar investment in its own hospitals, physicians, outpatientservices and medicals malls by limiting its subscribers’ access to competitors, including UPMC and the region’s community hospitals.”

Referring to Highmark’s ubiquitous tagline, “Accepted Everywhere,” Wood said, “Apparently to Highmark, access to ‘Everywhere’ does not apply to Medicare subscribers.”

About UPMC

UPMC is a $10 billion global health enterprise with more than 55,000 employees headquartered in Pittsburgh, Pa., and is transforming health care by integrating more than 20 hospitals, 400 doctors’ offices and outpatient sites, a health insurance services division, and international and commercial services. Affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is redefining health care by using innovative science, technology, and medicine to invent new models of accountable, cost-efficient, and patient-centered care. 

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