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UPMC, Highmark Finalize Agreement, Details Released

Pittsburgh-based UPMC and health insurer Highmark have not extended their current contract, but the organizations have come to an agreement that will allow Highmark members to receive medical care outside of the greater Pittsburgh area at in-network rates beginning in 2015.

The current contract between the two organizations is set to expire at the end of the year. Without a new contract in place, more than 1 million Highmark members were set to no longer have in-network access to UPMC providers — a concern given UPMC's positions as the dominant player in the regional market.

The contract dispute between the two grew to such proportions that the government intervened. Pennsylvania lawmakers drafted legislation that would force UPMC and Highmark to work together. Under the legislation, integrated delivery systems would be required to accept patients covered by "any willing insurer." The bipartisan legislative effort was led by Rep. Jim Christiana (R-Beaver).

Under the agreement, a five-year transition plan has been put into place that will allow some Highmark members to pay in-network prices for services offered by UPMC outside of the greater Pittsburgh area. 

"I am thankful Highmark and UPMC agreed to work together to ensure patients will not be turned away because of a logo on their insurance care," said Rep. Christiana, in a news release. "My hope all along was to find a way to give affected Pennsylvanians peace of mind about their healthcare options without relying on a legislative solution."

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