Highmark, UPMC To Part Ways

PITTSBURGH (KDKA) — There is a huge change coming in health insurance for millions of people in Pennsylvania as UPMC and Highmark are parting ways.

UPMC, the area’s largest health care provider says it won’t renew its contract with Highmark, the area’s largest health insurer.

It stems from Highmark’s reported efforts to acquire the West Penn Allegheny Health System.

UPMC says: “With Highmark having announced its intention to compete with UPMC as a provider, there cannot be any prospect of a contract renewal between UPMC and Highmark.”

The contract expires June 30, 2012.

One of the area’s largest health care consultants says consumers can expect to pay more.

“Most employers, most employees end up having to spend a little bit more for coverage now because the cost of health care is so expensive,” said Lorin Lacy, of Buck Consultants. “So, it’s already straining budgets for consumers today and this will only make it worse in that regard, I believe.”

Highmark subscribers can continue to use UPMC hospitals until June 2013, but may have to get permission first and pay higher fees.

However, UPMC’s 2,800 doctors would be out of network, which some Highmark subscribers say would cost too much.

“I wouldn’t be able to pay and I’d have to scramble to find someone,” said Andrea Fedoronko, a Highmark subscriber. “In a year, that doesn’t give you much time.”

Highmark says “We will take every measure necessary to protect our members and to make sure they can continue to receive uninterrupted care at UPMC physicians and UPMC hospitals through mid-year 2013 with no special approvals or permissions required while reimbursing UPMC physicians as in network providers.”

But UPMC says that won’t happen.

After next June and for several years, Highmark subscribers would continue to have access to just two UPMC hospitals, Children’s Hospital and Mercy Hospital.

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Comments

One Comment

  1. Paula says:

    Pretty soon, UPMC will be the only game in town…..

    1. One small voice says:

      That’s their Goal, a closed market.

    2. T says:

      NOT really not every hospital is in their dictatorship and frankly Highmark is a much better insyrance carrier I have had both and would not trade my Highmark for any UPMC policy

    3. anonymous says:

      As big as they may think they are, they are not bigger than the government! VA Hospitals are nationwide and give quality of care!

  2. Typical UPMC says:

    Anyone who has any dealing with upper management at UPMC knows they want to be the only game in town. They expect everyone to pay out the nose for their services…..but yet they expect their vendors and employees to live in poverty. As typical in Pittsburgh this organization is as corrupt as can be…and it starts with Romoff (the ring leader). UPMC’s only care is money…listen again…”MONEY”…they do not care about this regions health care. UPMC has disliked Highmark since the dawn of time….they just found a nugget of information to have a valid reason to ditch them.

  3. Raymond Kohan says:

    The report about highmark/UPMC needs to be updated. UnitedHealthcare is not accepted by all UPMC hospitals. Namely UPMC Presbyterian. Not only do they not accept UnitedHealthcare but we had to fight with both UPMC Presbyterian and UnitedHealthcare to get them to accept our insurance for an emergencyroom visit. Please verify your report with UPMC.

  4. 1-2-3 says:

    Non-profit, using its status to profit off the Public. They don’t put patient care first, money hungry, grreedy, organization. What is their Mission Statement ? Apparently they have forgotten their commitment to the the Regions healthcare. Open up your wallets.

  5. LK says:

    Every Doctor and hospital should accept every form of insurance, period.

  6. Bea says:

    So, their non-profit only applies not paying any taxes? Do you hear other non-profits saying they won’t deal with an organization who competes in the same area? The quality of UPMC’s care is so poor because they try to get as many people in as possible to their “specialists”. You get about 10 minutes for care. But, the cost of that 10 minutes? Hundreds & hundreds of dollars.

  7. Bob says:

    Great. So now, the region’s most overwhelmingly pervasive insurance will no longer be accepted by the region’s most overwhelmingly pervasive provider. How does that work? How can that work? UPMC instigated this battle, when they ventured outside the realm of provider, and into the realm of insurer. Now they refuse to negotiate with Highmark, because Highmark is venturing outside the realm of insurer and into the realm of provider, in order to compete. I always saw the dual role of insurer and provider to be a direct conflict of interest, and a barrier to true competition in either market. Insurance companies already have too much control over what care is provided to whom and when. When the insurer is also the provider, no one is there to act as an advocate on behalf of the patients’ true needs. UPMC should not have been allowed, and Highmark should not be allowed. As usual, no one cares about the needs of the consumer. But after all, it’s only healthcare.

  8. T says:

    Highmark has better coverage anyways so switch your provider now and out with the UPMC monopoly!

  9. T says:

    Also remember there are also many other non UPMC quality facilities in the area so if UPMC does not want to take your Highmark insurance then take your Healthcare and your dollars elsewhere. I am sure they will be thrilled with the multi million dollar loss of revenue .

  10. Lisa says:

    Highmark and UPMC are acting like children, so person said that so I’m not going to play with you anymore attitude. They should both like about the people who need medcial help

  11. Baker6 says:

    Lisa. What are u saying? Lay off the crack

  12. Truth says:

    UPMC is an institution totally fueled by greed and arrogance. Having worked in healthcare in this region for about 20 years and, at one time or another having been employed by either UPMC or Highmark, I can assure you it’s UPMC who’s the bad guy here. This is nothing but a money grab on their part, trying to sell their own insurance product.The only concern UPMC has for the well-being of memers of this community occurs in the scripted scenarios conjured up by their ad agency in their TV commercials. UPMC truly is bringing about the downfall of a once great regional health care industry. They are a disgrace.

  13. teresa says:

    Finally the FALL of UPMC!! what goes up must come down!! they have tried to put every healthcare system out of business and FINALLY someone is challenging them…Congrats HIGHMARK!! I already refuse to go to any UPMC doctors!! CORRUPT!!!!!!!!!!!!!!!!!!

  14. RRRJR says:

    I find this entire dispute very interesting. UPMC has a health plan, hospitals and doctors. Highmark is looking to preserve competition in the Pittsburgh market by doing exactly the same thing as UPMC and they want take their marbles and go home.

    Where are the regulators when you need them? I have believed for a long time that UPMC should not have been permitted to take on the role of Insurer and provide for a long time and this is the reason.

  15. suzie says:

    Why is healthcare so expensive? Simple. Greedy insurance companies, greedy pharmaceutical companies and corrupt politicians.

  16. swin says:

    I’ll tell you how the citizens can put a stop to this right now. PITT is a state related institution. Write your congressman. Tell him that if Pitt refuses to accept a private insurer at any of their hospitals, then the Commonwealth of Pennsylvania should terminate all financial assistance to the institution.

    1. Russ says:

      Are you aware that less than 40 per cent of the students in the Pitt Medical School are residents of PA, yet they receive and want more millions from PA taxpayers. I’m not sure, but have been told that the rest are foreign students going there on our dime.

  17. Russ says:

    Highmark subscribers should start looking for doctors and hospitals outside of the UPMC plan. there’s AG in Pgh. and Ruby close by in WV. Once UPMC starts finding their facilities near empty, they will change the way they do business.

  18. swin says:

    Are you beginning to see the early workings of Obamacare in all this? Obama will force you to purchase health insurance and the insurance will only be available through monopolies (that, as in Pitt’s case, operate under public subsidy, i.e. taxpayer money). And all of this is supposed to save you money.

    Are you beginning to get it yet? A complete government takeover of health care and you are at the mercy of Washington bureaucrats. You better believe that what is happening here between Blue Cross and UPMC is happening, or will happen, throughout the country.

    1. Truth says:

      Huh???? UPMC has been positioning themselves for this for YEARS. They threatened to do this about a decade ago when Highmark was offering to loan West Penn AGH money. This has nothing to do with health care reform. UPMC is, was and always will be greedy. That’s what this is all about. You seem to be missing the point here.

  19. swin says:

    The bottom line here is that a health provider and a health insurer combined is a gross conflict of interest and a defacto monopoly that should never be permitted.
    This was always the risk to UPMC becoming an insurer – it just took a few years and the passage of Obamacare for the dragon to raise it’s ugly head.

  20. swin says:

    Everybody who is insured with UPMC and who is able to switch needs to drop them now, before this monopoly takes control. Where I work, I had the option of which one to choose – I never ever even considered UPMC – now it’s obvious why I made the right choice.

  21. swin says:

    Don’t you get it? Once you are a patient at a UPMC hospital and you are covered by UPMC health insurance, the only care you are going to get will be care that will maximize their profit. Your health will be of no concern to them.

    1. ihateupmc says:

      Your health is no concern to them now. Will be even less so later!! They served my wife rotten orange juice, actually had mold floating through it, last time she was in the hospital. They didn’t even care. Never even brought her any fresh. Then they kept her there for a week for a severely bloated and upset stomach. Just pumped her up with drugs over and over, then released her and told her nothing was wrong. We traveled 30 miles to the nearest out of network hospital. In 10 minutes the found she had H Pylori!!!! UPMC is completely and totally incompetent and needs to be broken up, plain and simple!!!

  22. Tom says:

    West Penn has continued to downsize staff which can only lead to a reduction in quality of care. Without Highmark’s influx of cash Pittsburgh would lose another option to UPMC which is exactly what they want and is the reason they are “taking their ball and going home”. Hghmark never intended to become a healthcare provider but has been forced to in order to give people in this area options.
    I am glad to see in reading all the other posts that people understand who the “villain” is in this situation and that only by turning to other providers for services will we affect any damage on their pocket books and bring about change.

  23. Carrie says:

    This is why medical service providers should not be allowed to provide insurance. It’s unethical and promotes monopolies. This is something that should have been addressed in Obamacare but wasn’t. Healthcare reform should mandate that all healthcare providers must accept all health insurance. This is ridiculous!

  24. Jani says:

    How can this possibly be a good business move for either company? Highmark customers would loose the availability of thousands of doctors, while UPMC would lose thousands of current patients.

  25. Kay says:

    Why would a tax exempt organization take their ball and go home over a perceived competitor? Why would a tax exempt sabotage care in a poor community and build in an affluent one? Why would a tax exempt nickel and dime consumers with such charges as double-dipping facility fees? Why would a tax exempt only “give” to the community in very visible positive image creating endeavors which provide leverage with the local government? Why would a tax exempt expand outside its home area and country and neglect it’s local subscribers?Why would a tax exempt need to position its logo to tower over the downtown area? Why would a tax exempt pay it’s executives outrageous sums? Why would a tax exempt, when faced with competition, resort to bullying and intimidation to eradicate the “opposition” rather than see it as another helpful option for the community? Why would a tax exempt prevent access to a woman’s hospital, a children’s hospital and a cancer center? Why would a tax exempt put profit, influence and prestige over service? Why would a tax exempt be unaware or not care about the damage and pain it may cause millions?

  26. frustrated says:

    How do you spell monopoly…UPMC.. How do you spell arrogance..ROMANOFF..
    both spell GREED also… How can a non profit brag about the billions they earn as they close community hospitals..(watch out McKeesport, you’re next)
    And how does a hospital operate thier own health insurance without it being a conflict of interest? … We need a choice in Pgh.. you might as welll go to AGH ,
    UPMC buys all thier docs from them, from the great Maroon to oncologists to
    cardiologists…. and with all the great news about thier transplants… AGH does transplants too……

  27. objectivity says:

    i find it annoying how quickly we can rag on UPMC. non-profit does not mean, necessarily, that they are not competitive or do not care about making profit – it just means that instead of paying out to shareholders and paying taxes they have that money to reinvest in the system. would you want a hospital system to pay out to shareholders rather than invest in their infrastructure? how much do people love the new children’s hospital? millions of dollars in charitable care are provided through ER visits and donations to the community and financial assistance every year.
    This move is about competition and strategy (like any other business would consider)…i have heard many people say they want more competition in this area in healthcare, that UPMC is a monopoly…well here you go. you are getting your competition. Happy? WPAGH is no less greedy and no more altruistic than UPMC. They are both large systems fighting for market share and using the leverage they have. i am not saying that I support the UPMC/Highmark decision, but i understand why this has happened. WPAGH could have made similar decisions in the past, but didn’t, though I doubt that was because of any sense of community. Maybe as a result, we will have two more even health systems.
    What is at the heart of this is that employers and insurers should not be the ones dictating what provider you should see. I agree with some other statements above, that all providers should accept all insurances. Now wait a sec…isn’t that something like a single payer system? 🙂 please, bring on reform.

    1. wake up says:

      You must be a UPMC employee.. are you serious, the want to be competative,
      http://www.bizjournals.com/pittsburgh/news/2011/02/10/upmc-operating-margin-rises.html check out this link, 4.2 billion dollar profit for 6 months for a non profit is pretty impressive. Tell the people of Braddock that 4.2 billiion is just being competitive… and as far as giving away free care, every hospital in the area from Childrens to Mon valley take care of patients without ability to pay, but it hurts the small hospitals far more that the few millions UPMC gives… Thier tactics are not to make money for the community, but to put others out of buisness. And they are aggressive and tactical in doing so.

      1. sigh says:

        I do not work for UPMC, but I do work in health care and am familiar with health care systems. your link shows they made a lot of money, but it’s profit margin was less that those of other hospitals in the area. i’m not saying anything about agreement with their moves (in fact, i was quite disappointed to hear about closing Braddock) i’m just saying i understand them. they are operating as a business and moving strategically, like any other business would do and I wouldn’t expect any less. i am angry not at UPMC for making the decision that they felt was economically beneficial (actually i think they are taking a huge gamble, going head to head), but at the healthcare system as a whole. if you had the choice of affordable health insurance, you could chose which system you wanted to go to, but no – insurance is through employers, so you have to go with whatever is economical for them. your choice is limited and the market gets out of whack. people want competition, but healthcare isn’t like other markets and it won’t mean the same thing.

    2. ihateupmc says:

      You obviously do work for UPMC. NO ONE and I mean NO ONE that does not work for them has anything good to say….. and for good reason. The quickest way to die is to enter a UPMC owned facility. Why do you think that the Doctors at Hamot in Erie fought TOOTH and NAIL to keep them out??? Hamot USED to provide excellent health care, in fact, I made certain my wife knew that if I had a major health event that Hamot was my choice, not UPMC. NOW, I will die regardless because after UPMC has implemented all of their so called “reforms”, there will be a mass exodus of all the best qualified doctors just as happens at EVERY UPMC gobbled up hospital.!!!!

  28. megsmusic says:

    How do we change this? What can we do? I have Highmark, kids and UPMC runs Children’s Hospital. Can’t we do something to fight this?

  29. pghdan says:

    The state could pass a law to stop this sort of thing.

    1. superwench says:

      They wont…probably a lot of money going to fund elections

  30. superwench says:

    UPMC wants to be the only provider in this region. I would not trade Highmark for any other coverage. UPMC is in it for all the wrong reasons. Keep Highmark…….get rid of UPMC

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