UPMC & Highmark Clarify What New Agreement Means For Consumers

PITTSBURGH (KDKA) -- In the celebratory zeal of the moment announcing the 10-year agreement between UPMC and Highmark Attorney General Josh Shapiro said, "All UPMC hospitals and practitioners are now an option for Highmark's ensured."

That lit up the phones at insurance broker Mediconnect with folks saying to the company's President Brian Breisinger, "I have Highmark insurance and I'm now being told I have access to all the UPMC doctors and facilities."

Breisinger says that is not quite the case.

"There are these high-quality low-cost plans, Community Blue is one of them, that are not going to be impacted by this agreement, they are still going to be restricted to the Allegheny Health Network because they never were part of the UPMC network, to begin with."

Community Blue is an attractive Highmark option because of its lower cost, but subscribers knew going in there is no UPMC access and this agreement doesn't suddenly open the UPMC doors.

Breisinger says on the other hand, "Folks that are on Freedom Blue and Security Blue with Highmark that were Medicare beneficiaries, they were going to be impacted by this breakup and they now have access to the UPMC network."

That's because those plans included UPMC all along.

On the other side of the agreement, UPMC insurance holders are not going to suddenly have access to all Allegheny Health Network facilities.

Breisinger says, "As far as it stands today there's going to be limited access for those who have UPMC as their insurer."

Currently, UPMC has only entered into coverage agreements with Jefferson Hospital in Pleasant Hills, and St Vincent Hospital in Erie.

Highmark CEO David Holmberg says the consumers are the winners, "Individuals, employers, and groups can choose coverage based on what their needs are."

Thanks to the ongoing battle of the health care titans a lot more companies have come into Western Pennsylvania to offer alternatives.

UPMC spokesman Paul Wood points out, "In a market where there are a lot of insurers, where no insurer has a dominant position, that bodes well for consumers in terms of price."

Breisinger says, "The marketplace has changed dramatically in the last five years. There are 35 options to consider in Allegheny County alone for folks that they need to be considering especially on the individual side. And many of those insurers also offer access to AHN and UPMC.

Breisinger says plans, options, and prices are constantly changing so a year review of your plan is a must.

That way you could potentially save money while making sure your plan best fits your needs.