What Highmark, WPAHS Affiliation Means For You

PITTSBURGH (KDKA) - Most people think of Highmark as an insurance company and UPMC as a medical provider.

But the lines are getting blurred.

UPMC has its own insurance plan, and today, Highmark said it was buying West Penn Allegheny Health System to provide health care.

All of this can get pretty confusing to the consumer.

Highmark is this region's number one health insurance company, covering 65 percent of people in this area.  So, what does it mean that Highmark is becoming a health care provider by buying West Penn Allegheny?

"It means you will have access to a world class health system for the foreseeable future in addition to all those other institutions, we continue to do business with and elect to do business with us," says Dr. Ken Melani, CEO of Highmark.

But after June 30, 2012, Highmark subscribers will no longer have access to the largest health provider in the region - UPMC - unless they pay much higher out-of-network costs.

That's when Highmark's contract with UPMC expires. UPMC tells KDKA Money Editor Jon Delano that they have no intention of renewing it because UPMC doesn't want to, in effect, subsidize their new healthcare competition.

At the same time, if you're among the 15 percent who have the UPMC Health Insurance Plan, nothing really changes. That's because those insurance subscribers are already barred from using West Penn Allegheny services except at a much higher out-of-network cost.

"Do you see the Red Cross trying to take down the Salvation Army? I don't think so. But that's what you see in this marketplace as UPMC has attempted for  [over] 10 years to put our health system out of business," West Penn Allegheny Board Chairman David McClenehan said.

Ironically, both Highmark and UPMC claim they want more choices and lower prices for consumers.

It sometimes feels like the consumer is getting caught up in the battle between these two old rivals.

In the end, competition may be good, especially if it brings down prices. But, it also means consumers need to choose carefully which insurance best suits their healthcare needs.

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West Penn Allegheny Health System
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