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Insurance Commissioner Gets Involved With UPMC, Highmark Talks

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Jon Delano Jon Delano
Jon Delano is a familiar face on KDKA-TV, having been the station's...
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CBS Pittsburgh (con't)

Affordable Care Act Updates: CBSPittsburgh.com/ACA

Health News & Information: CBSPittsburgh.com/Health

PITTSBURGH (KDKA) – Insurance giant Highmark said it wants to cut a deal with medical provider giant UPMC so their customers can use UPMC services well into the future.

So far, UPMC is not willing to play ball.

Now, this dispute has drawn the attention of Pennsylvania Insurance Commissioner Mike Consedine.

“Ultimately, we would like to just see them reach a decision that is hopefully in the best interest of the community out in Western Pennsylvania,” Consedine said.

Consedine told KDKA Money Editor Jon Delano that he shares concern that those families insured by Highmark may be denied the use of UPMC’s doctors and hospitals.

“Any time we hear from consumers, especially insurance consumers, that they don’t understand, they’re alarmed, they don’t understand what will happen to their health insurance, as good regulator that’s something we need to be aware of and respond to,” Consedine said.

While he wouldn’t discuss any details, Consedine said he’s met with officials from both companies and will continue to do so.

In a lawsuit filed Wednesday, Highmark accuses UPMC of false advertising by trying to scare Highmark customers into switching to other insurance companies.

If Highmark and UPMC cannot reach an agreement by July 1, 2012, Highmark customers could lose access to UPMC services one year later in July of 2013.

As part of this ongoing battle between Highmark and UPMC, UPMC has just signed some deals to allow some other insurance companies to use their facilities and their doctors.

Among those insurance companies are Aetna, Cigna, Health-America, and United Healthcare.

Jim McTiernan of Triad USA advises companies on health insurance. He said both Highmark and UPMC need each other.

“Highmark would represent currently a vast majority of their private patient payments, which is really the only place a hospital can make money these days,” McTiernan said. “So to abandon that much of the market would be pretty difficult.”

McTiernan is not surprised that the Insurance Commissioner is getting involved.

“It’s obviously at the forefront of the public, and it doesn’t surprise me that they’re speaking up now,” McTiernan said.

Consedine said he cannot force the parties to reach an agreement, but he can invoke a state law called Act 94.

“It’s certainly one of the options that we’re keeping on the table,” Consedine said.

Act 94 allows the commissioner to extend an expired contract for six months so the parties can ‘cool off’ while Consedine mediates a deal.

Consedine hopes that won’t be necessary.

He wants both Highmark and UPMC to continue talks as “good corporate citizens” and “in an accurate, non-flammatory way.”

“These are both two big companies that play a very important role in that community, and we hope they can find a solution that really puts the interest of the community as a priority,” Consedine said.

In the meantime, Commissioner Consedine has some simple advice for consumers.

“Don’t panic. We’ve seen a lot of these contracts go down to the wire and ultimately some kind of agreement is reached.”

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