Highmark, UPMC CEOs Testify Before State Senate Committee

PITTSBURGH (KDKA) — Top officials at Highmark, led by Dr. Kenneth Melani, and UPMC, led by Jeffrey Romoff, testified before a Senate banking committee today looking at ways to keep UPMC doctors and facilities open to Highmark customers after a contract expires in June 2013.

Following Romoff’s testimony, KDKA Money Editor Jon Delano confronted him with a question many health consumers are asking.

Delano: “Tens of thousands of Highmark subscribers love their UPMC doctors and their UPMC facilities. How can you deny them the opportunity — at the same cost — to use those facilities and doctors?”

Romoff: “They will have opportunities at lesser cost to use those facilities. They will have five health plans, insurance companies, to use to get to UPMC facilities.”

In Romoff’s view, it’s all pretty simple. If you want UPMC doctors, drop Highmark insurance and sign up with another insurance company.

“I think the battle here is very hard to understand, and the public does it’s very best to do so,” says Romoff.

Delano: “But from the public perception, these are just two giant monopolies fighting each other and the public is getting lost in the middle. Do you see it that way?”

Romoff: “I see these as two giant organizations that are trying to do the best for the public, and there is not an opportunity for us to do it together.”

So should the government order Highmark and UPMC to reach an agreement beneficial to the public?

“I think it would be a very unwise move,” says Romoff.

Absolutely, says Highmark’s Melani.

“We need legislation that prevents this chaos from ever happening again for any insurer across the state with any provider across the state,” insists Melani.

Melani wants legislation to give the state power to order arbitration between Highmark and UPMC, a position that Romoff rejected.

Delano: “What do you want state government to do in this situation?”

Romoff: “Very little. I think state government should assure that this transition period is orderly, should assure that we can get from Point A to Point B in a way that does no harm to any patient and not much more than that.”

But Melani says it’s Highmark that in saving West Penn Hospital is acting in the public interest.

As for UPMC, he notes, “Mr. Romoff is self-centered for his own purposes. He is centrally focused on his own corporate entity. He is not looking at the best interests of the people in the community. He doesn’t want competition.”

Romoff insists there’s nothing personal here — it’s just business.

Delano: “There’s no room for movement on your part — if folks want to use UPMC and UPMC facilities, they have to go to a different insurer than Highmark?”

Romoff: “Ultimately, that will be the case.”

In the meantime, state lawmakers are looking at legislation to force a cooling off period, mediation or arbitration on the parties.

Highmark customers do not lose access to UPMC until June of 2013 — and some facilities, like Children’s Hospital, will remain covered for years to come.


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One Comment

  1. Just settle this.... says:

    UPMC is upset with HIGHMARK…really?? If I remember correctly, UPMC started their own insurance carrier a few years ago so technically they “started” this. Just because their insurance (UPMC) can’t seem to compete with Highmark, now there’s a problem. The fact that Highmark is now getting into the provider side makes it more “even”. Is there a problem with them making each other’s health systems in network and then the consumer/insurance carrier/patient wins??? For two nonprofits, nothing less will be acceptable.

    1. S.Patrick. says:

      I agree. UPMC is acting like a competitive profit company, with disregard for the well being of the subscribers to the largest insurance carrie in the region, and in a field that is supposed to be altruist AND non-profit. I think Corbett should hit them hard, bust up the boards of directors, make them get care at their own facilities.

  2. Derrek says:

    Isn’t this what we wanted? Competition? This is how we keep costs down…the change will be beneficial to all of us.

    1. Pat says:

      You’re an idiot. Competion should not be in health care. Do you honestly think this will bring costs down??? Co-operation and resolution should be directed by the government. Romoff is a sociopathic, greedy pig. His stupid comment that we have 5 other insurers to pick from shows his egotism. He knows most of us don’t have a choice. We have to go with whom our employer offers.
      UPMC is a profitable business and Romoff is reaping the rewards at the peoples expense.

      1. EnoughAlready says:

        Romoff is singlehandedly pursuing a course of action which will have a detrimental effect of the health and welfare of hundreds of thousands of people in UPMC / Highmark service area. Meanwhile the board members of UPMC are sitting around doing nothing to stop it. The UPMC board members should be held in the same contempt as Romoff because they are allowing him to keep his job. Romoff should be fired and replaced with someone who has the best interest of the UPMC patients as his / her top priority not some personal grudge or delusion of empire building. At the same time our politicians should stop holding hearing and talking. We need action. The clock is ticking and everyone who has UPMC physicians and Highmark insurance is suffering facing a loaming healthcare disaster.

        It is time for the boards of UPMC and Highmark to stand up and replace these individuals who clearly do not care about the welfare of their patients and insured. It is time for the politicians to step up and put and end to this situation NOW!

  3. dansuxs says:

    Highmark services Medicare and Medicaid contracts. The Feds mandate and regulate how much an MD or Hospital can collect for these providers. Traditionally hospitals make up for these loses by charging higher rates to other insurance providers. Highmark does not want to agree to proposed rate increases for it’s non regulated customers …so they cut off their nose to spite their face and purchased AGH/West Penn. In the process they ruined a proposed merger with AGH and the Cleveland Cancer Clinic. That merger would have been real competition between hospitals and great for our region.

    Highmark is run by a bunch of arrogant idiots.

  4. Sparky says:

    Costs for both Companies will now escalate as they hire lawyers to defend their positions and the subscibers will pay even more in the end. Take away their non-profit status and see how fast they settle up. According to Post Gazzette article, Oct. 28, 2011.[.Smaller rise in Medicare premiums set for 2012] ..It stated average premiums for Popular Medicare Advantage plans will stay flat or dip slightly in 2012. However every plan for Highmark and UPMC went UP.UP..UP,in costs, and co-pays, here in the Pgh area…WHY?????

  5. bruceUSA says:

    Once again GREED is the ruler of the day. You would think these “humble” men would be trying to seek better ways to serve this region. Real “humanitarians” hard at work !!! LOL!!!

  6. swin says:

    1. There should be no state funding for Pitt/UPMC – they are taking our tax dollars and making mucho profits with them.

    2. By law, a health insurer should not be allowed to be a health provider – talk about a conflict of interest.

    Who do you think will receive the higher bill at a UPMC hospital – a person with UPMC coverage or a person with Blue Cross coverage?

    Now also consider this – you have UPMC coverage and you are a patient at a UPMC hospital – UPMC will have to pay for all your care, your tests, your procedures, etc. etc. Now do you really think they are not going to cut corners? In other words, the better care you get the more it will cost them and the less profit they will make.

    I’ll say it again – a health care insurer, by law, should not be allowed to be a health care provider.

    1. MJ says:

      Pitt and UPMC are two seperate entities. Do not confuse them for the same one. Otherwise, I totally agree with your comment.

  7. bruceUSA says:

    Funny the names say it all—– Highmark (yea the higher they can mark up medical costs the better) UPMC—- UP (with the) Medical Costs.

  8. MustafaJohnson says:

    This is an inexcusable crime. If our politicians can’t do something about it then they should get tossed. UPMC says just get another insurance as it it’s that easy. You have to take what your employer gives you. Romaff is a moron to even make a statement like that. All their ads say they care about the people……….what a bunch of BS. I think he has a personal issue with someone at Highmark. Maybe it’s time to Occupy UPMC/Highmark. Take away their tax exempt status. If not that, there are ways.
    Hey politicos pretend its a new tax you want to put on the citizens. Bet you could get that accomplished.

  9. larry gurmet says:

    those 5 health insurance companies romoff cited are only taking commercial/employer accounts. what if you employer does not want to change? also, there are a quarter of a million highmark direct subscribers who lose access to upmc, what about them? no one sells individual products unless it comes with a pre-existing condition exclusion. john delano could have done a better job

  10. sandyd says:

    I have Cigna insurance. I was recently charged a $234.00 “facility” charge by UPMC in addition to my doctor’s bill for just walking into their building. This was just a 5 minute doctor’s appointment, nothing special was done. They never notified me of this charge when I made my appointment or while at the doctor’s office. When I called to question this fee, they told me that the location is now considered a “facility” and can now charge the additional fee.

  11. EnoughAlready says:

    Pass a law stating a healthcare provider cannot own a health insurance plan and a heaith insurance company cannot own a health care provider.

    Then pass another law that splits up UPMC and sells the facilities to a health system who wants to operate in this area and splits up Highmark and sells its customers to a company who wants to provide health insurance in this area.

    That will get UPMC and Highmark to work it out.

  12. EnoughAlready says:

    Write to US News & World Report. How can they rate UPMC high when UPMC is totally disregarding the welfare of the people of this area?

Comments are closed.

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