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Highmark's post-UPMC transition plan leaves questions unanswered

Most of Pittsburgh-based UPMC's physicians will remain in-network for Highmark members after the contract between the two organizations expires at the end of the year, according to Highmark's transition plan.

In June, Pennsylvania Governor Tom Corbett (R) announced UPMC and Highmark had entered into a five-year transition agreement that would allow Highmark enrollees to be covered by their out-of-network coverage rate, though UPMC services provided outside of the greater Pittsburgh area would remain in-network for Highmark customers.

However, after Gov. Corbett announced the agreement, it appeared Highmark and UPMC did not reach the same understanding concerning the terms of the agreement, as UPMC sent a message to health insurance brokers and others picking apart Highmark's interpretation of the separation agreement. The message indicated a Highmark advertisement had left out important details of the agreement.

After the separation agreement was announced, lawmakers felt there was still more work to be done, as essential issues were left unresolved by the contract. Rep. Tony DeLuca (D-Penn Hills) sent a letter to Gov. Corbett seeking answers, as he felt there were many specialty care, emergency care and continuity of care issues that were far from resolved.

Many were hoping Highmark's post-UPMC transition plan, which was made public by Pennsylvania's Insurance Department this week, would provide answers to the unresolved issues, but that did not happen. 

The plan states 80 percent of UPMC's physician's will remain in-network for Highmark members, as Highmark treats UPMC physicians who practice at another in-network hospital system to be in-network for Highmark members. However, UPMC disagrees and intends to take its complaint to state regulators, according to a report by the Pittsburgh Post-Gazette.

UPMC and Highmark also failed to agree on the rates UPMC will charge Highmark members for emergency department visits.

The transition agreement did provide some positive news for Highmark's Community Blue members, who will be allowed, for the first time, to go to UPMC physicians and access the health system's hospitals, if they pay out-of-network prices. The transition plan does call for the out-of-network-charges to be discounted by 40 percent.

More articles on healthcare industry transactions:

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