By: Catie Hohman

The lengthy 8-year war between Highmark and UPMC has come to an end! Or a 10-year delay at least… UPMC and Highmark have been fighting back and forth since 2011 and it has been impacting their employees as well as patients, but now it seems that the problem has been resolved, thanks to Attorney General Josh Shapiro.

However, that does not change the fact that both companies have put their patients and customers through a lot of stressful experiences,  frustrating the community further with the ongoing one-upmanship through commercials and advertising battles. Further investigation is needed to assess what damage has been done, but we can continue to celebrate the resolved problem… at least temporarily.

Photo by: Catie Hohman

Highmark and UPMC have been under a Consent Decree since 2012 which has forced the companies to allow those with Highmark insurance to use UPMC hospitals and doctors and those with UPMC insurance to use Highmark resources.

Two years later, in 2014, the Consent Decree was pushed further as Highmark and UPMC created a Consent Decree with the then Attorney General Kathleen Kane and the Pennsylvania Departments of Health and Insurance. The expiration date was set to June 30th, 2019, a deadline that is soon going to expire.

Photo by: Catie Hohman

This decree has protected those who need to receive emergency care or specialized treatment by allowing them to use the world-class facilities and renowned doctors from both UPMC and Allegheny Health Network hospitals. As well as letting regular citizens have access to hospitals and doctors they would not have otherwise.

On October 1st, 2018, UPMC announced that when the Consent Decree expired, those with Highmark insurance would no longer be able to have access to their hospitals or doctors unless they paid their estimated hospital bills in advance, much to the dismay of the elderly, pregnant mothers, and those who needed immediate and constant care.

This was seen as a very aggressive and surprising move to Highmark spokesman Aaron Billger who described the decision in an interview with the Pittsburgh Tribune-Review as “an extremely unusual move”.

The Attorney General of Pennsylvania, Josh Shapiro, announced June 24th, 2019 that UPMC and Highmark have come to an agreement. Shapiro said in a press conference Monday the 24th, “These two health care institutions will now be able to return to regular order, focusing on solutions rather than problems.”

All those insured by Highmark will now be able to have access to UPMC hospitals, including all of the specialized care facilities like Magee Women’s Hospital in Pittsburgh and the Hillman Cancer Center in Pittsburgh. Children’s Hospital is also still available for use to Highmark members which was specifically a concern of families living in the Pittsburgh area.

This agreement allows those with Highmark insurance the ability to use many UPMC hospitals at an in-network rate. But Highmark has many listed as out-of-network so they can encourage those with Highmark Blue Cross Blue Shield to use hospitals owned by Highmark.

In a phone interview with Carmella Breslin, Senior Project Manager at Highmark, she says that Highmark’s main focus and their CEO David Holmberg’s main focus is improving the quality of healthcare while decreasing the cost, and it has been this way since Holmberg first joined Highmark in 2007. Breslin says, “Moving forward will be interesting.” If anything is really known about the situation, it is certainly that. UPMC refused to comment on the subject.

It is not known yet if UPMC’s decision to no longer accept Highmark insurance really influenced anyone enough to switch insurance carriers but in the renewal periods for Medicare in October, and other insurance in July of 2019 and January of 2020, Highmark will be able to tell how much clientele was actually lost during this period, according to Breslin.

All in all, the focus has come back to the people which is why healthcare is even needed in the first place. UPMC and Highmark have worked together in this business since 1998 when UPMC announced they would be selling health insurance and according to Breslin, Highmark was happy about that change occurring 20 years ago, because the extra competition allowed consumers to overall benefit from lower costs.

Concerns of patients moving forward, will of course remain prevalent and Breslin says they were a major influence in the finalization of the Attorney General’s decision, but mentions that only about 10% of Highmark insured patients are currently using UPMC hospitals or doctors.

While this ten year agreement is a relief to many, this past competition which has now morphed into a working relationship will need to be tested before we can see how much of an impact was left on the people of Western Pennsylvania.