Wolf Administration Broadens Number Of Highmark Customers Eligible For UPMC Care
PITTSBURGH (KDKA) -- The Wolf administration says it will interpret last year's consent agreement between Highmark and UPMC in a broader way than its predecessor.
That's good news for Highmark customers who have been using UPMC.
It's a bit legalistic, but more Highmark customers may be able use UPMC facilities at lower in-network rates under a consent agreement Highmark and UPMC signed last year.
"If there is an individual who is in a continuing course of treatment with a UPMC provider and the provider and patient decide that it is best for that patient to continue in that relationship, then that is what is to happen," says Ron Ruman, spokesperson for the Pennsylvania Health Insurance Department.
UPMC says this is a broader interpretation by the Wolf administration than the Corbett administration had.
"What Governor Wolf and his administration have done is they've adopted a very pro-consumer, very inclusive interpretation of the consent decree," UPMC spokesperson Paul Wood told KDKA money editor Jon Delano.
Under the original agreement, Highmark customers could continue treatment at UPMC after Jan. 1 under a "continuity of care" provision.
But the Corbett administration claimed that this did "not" include basic preventive care, non-serious, or non-recurrent illnesses and injuries.
The Wolf administration says the agreement did not contain those limitations.
"We're going to come down on the side of the patients," said Ruman. "Governor Wolf and Commissioner Miller have made it very clear here that their interest is making sure that consumers are protected and that is the standpoint from which we are viewing this consent decree."
While UPMC says this is good news for their patients who are insured by Highmark, Highmark says, there is no new news here at all.
Highmark says they've been following the consent decree all along.
In a statement to KDKA-TV, Highmark spokesperson Aaron Billger said, "The continuity of care definition in the governor's news release implies an existing condition that a patient is under treatment for - such as an injury or illness - and therefore the patient needs to continue that care. In that regard, we see it as consistent with what we believe."
"It's a huge win for patients," noted UPMC's Wood. "It's a huge with for our physicians. It's a great win for the community."
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