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Pennsylvania insurer and health system agree on patient access

Both sides credit state lawmakers and the governor with helping to reach an accord regarding the contract's expiration.

By Emily Berry — Posted Jan. 9, 2012

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The millions of patients who see physicians affiliated with the University of Pittsburgh Medical Center and who also are Highmark members won't lose access to care or have to switch insurers until at least June 30, 2013.

The Pittsburgh-based Blues plan and the health system have not agreed on a new contract, but they did settle on when the current one expires. UPMC will be in-network for Highmark members for 18 more months, the two sides announced Dec. 22.

The battle between the health system and the insurer reflects a national trend of insurers getting into the business of providing care and hospitals getting into the insurance business.

Highmark has been openly pursuing acquisitions and affiliations with physician groups and hospitals after its purchase of West Penn Allegheny Health System. UPMC, which operates a health plan, sees Highmark's strategy as creating competition so it can drive patients to Highmark-owned facilities over UPMC physicians and hospitals.

The two sides have not come to an agreement about the issues that kept them from signing a new contract. But they credited state lawmakers and the governor with making sure the existing contract would be honored for a year and a half.

Highmark had maintained that the current contract had a "run-out" period of a year and did not expire until June 30, 2013, anyway. But UPMC said the run-out period applied only to its hospitals, not its physicians. The health system had been encouraging Highmark members who were UPMC patients to find new insurance before June 30, 2012.

UPMC said in a statement that the new date "provides 18 months for UPMC patients and Highmark subscribers to review the multiple competitive health insurance options now available to assure that their care will continue uninterrupted with UPMC physicians and hospitals."

"Highmark will continue to work toward achieving a long-term contract with UPMC that guarantees our members affordable access to all UPMC hospitals and physicians and preserves provider choice," the company said in a statement.

State legislation that would keep the current contract in place until a new one is reached remains pending.

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