Highmark’s response to the PA Attorney General’s announcement about the UPMC-Highmark Consent Decree

The Pennsylvania Attorney General has proposed that all charitable, nonprofit health systems will contract with all health insurers who want to do business with them. It is a modification of the current Consent Decree between Highmark and UPMC that will enable consumer choice moving forward. What this means is that consumers can choose their health insurer, doctors and hospitals.

Highmark has agreed to the Attorney General’s terms and believes in hospitals and insurers competing on a level playing field for the benefit of consumers. UPMC has not agreed to the Attorney General’s terms and the issue will now go to court.

What does it mean for me right now?

Right now, it means nothing – until we hear from the courts. Keep in mind that the Consent Decree that governs the relationship between Highmark and UPMC is in effect until June 30, 2019. We hope for some clarity before then.

What will this mean to me, if the court rules to support the Attorney General’s action?

If the court supports the Attorney General’s proposed modified Consent Decree between Highmark and UPMC, it will mean that charitable, nonprofit health systems must have contractual relationships with all health insurers who want to do business with them. This opens the door to allow consumers like you to choose your health insurer, doctors and hospitals.

What if the court does not support the Attorney General’s action?

If the court does not support the Attorney General’s proposed modified Consent Decree between Highmark and UPMC, it will mean you will need to choose your health care providers based on your health insurance benefits. Highmark has been preparing for the end of the Consent Decree with UPMC and is focused on the community and our member’s care. We have invested more than $1 billion in enhancing a world-class health system at AHN that offers choice and accessibility for our members.

What if I already switched all my doctors away from UPMC? Can I go back to them?

If you switched doctors, it was likely because of your insurance benefits. Until we have some news from the courts on the Attorney General’s proposal, you should stick with your current health care providers.

When will we know what the court says?

We hope to hear by the end of the current Consent Decree that ends June 30, 2019. But, as of now, we have no timeline to share.

What about all this building that is happening in the community with AHN? Do we need all of this stuff if Highmark and UPMC work together?

We believe that the best care for our members and patients is close to home and in the community. That’s why we have invested more than $1 billion in building out and enhancing a world-class health system at AHN – from the region’s leading cancer care working with Johns Hopkins to cardiovascular services, to women’s health and community-based care. No matter what the court ruling may be, we will continue to expand community care because we feel it is best for our members and patients.

Is AHN open to all health insurers?

Yes, AHN is open to working with all health insurers who express an interest in its outstanding facilities and doctors. AHN provides in-network access to most health plans including Highmark, Aetna, United and UPMC Health Plan. (UPMC Health Plan provides in-network access to its members at AHN’s Jefferson Hospital, AHN’s Saint Vincent Hospital and many AHN physician practices.) You should always contact your health insurer to determine your in-network access to doctors and hospitals.

AHN is a Highmark Health company and in 2013 the Highmark Board of Directors affirmed its belief in a resolution that said every patient has a fundamental right to seek and receive treatment from the physicians and hospitals of the patient’s choice; and, that every charitable, tax-exempt organization has a fundamental obligation to ensure that the community has open access to assets that the community has funded and supported.

The Board pledged that Highmark and AHN will provide access to its facilities and physicians to all patients regardless of their type of insurance, and that AHN will negotiate with all insurance providers in good faith to be able to offer in-network benefits to the subscribers of such insurance. These are beliefs and commitments we still hold today.

Pennsylvania Attorney General Statement

PA Attorney General filed a petition on February 7, 2019 to modify the consent decree between UPMC and Highmark. The petition requests that the Court impose modifications to protect and promote public interest by ensuring that UPMC abides by its obligations to the Commonwealth of Pennsylvania. The announcement is available on the Attorney General’s website.

WTAE Channel 4 Coverage of the Pennsylvania Attorney General’s Press Conference

Pittsburgh Post-Gazette: Attorney general files legal action against UPMC, saying hospital system has strayed from charitable mission

The Pennsylvania Attorney General’s office went to court Thursday to pressure UPMC to change its approach to rival insurer Highmark’s members, accusing the Pittsburgh-based hospital giant of being out of compliance with the state’s public charities law in restricting access to its doctors and medical facilities. Full article.

Was this article helpful?

Related Articles