Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Upmc, Highmark Feud over Network Physicians Number Remaining with Insurer Disputed

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Upmc, Highmark Feud over Network Physicians Number Remaining with Insurer Disputed

Article excerpt

A sharp disagreement has flared up between Highmark and UPMC about how many UPMC physicians will remain in Highmark's insurance network if the contract between the two Pittsburgh health companies expires Dec. 31.

The dispute emerged last week at a Pittsburgh Business Group on Health forum held at a Downtown hotel when Deborah Rice-Johnson, president of Highmark health plans, told the employer group that nearly 70 percent of UPMC-employed physicians would remain in Highmark's network next year based on a methodology that both sides had agreed upon.

In a presentation immediately following, UPMC officials took issue with Ms. Rice-Johnson's numbers.

"They said that was a lie, that they hadn't even talked to Highmark at all and they didn't agree to that," said Jessica Brooks, executive director of the business group comprised of some of the region's largest employers, a point reiterated Wednesday by UPMC spokesman Paul Wood.

"There are no agreements for UPMC physicians to be in-network for Highmark subscribers, except for services provided at sites specified" in an agreement mediated by Gov. Tom Corbett two years ago, Mr. Wood said.

But Tom Fitzpatrick, Highmark's vice president of provider contracting and relations, said Wednesday he has been meeting weekly with his UPMC counterpart since last summer, and every other week for the year prior to that.

He said the meetings have been held to work out details of the mediated agreement that extended the Highmark-UPMC contract through Dec. 31, including discussing rates and access to so-called "exception hospitals" that will continue to be in-network after this year -- UPMC hospitals such as Children's, Western Psychiatric Institute and Clinic, and some outlying hospitals such as UPMC Altoona, UPMC Bedford and UPMC Northwest that would continue to be in-network for Highmark members.

Mr. Fitzpatrick said many issues remain unresolved. But, he said, the two sides did have verbal agreement that UPMC-employed physicians who see patients at the exception hospitals -- or have clinical privileges at an independent hospital that is part of Highmark's network -- would still be considered in-network for people insured by Highmark.

So, for example, he said a Highmark member could be treated at the independent St. Clair Hospital in Mt. Lebanon by a UPMC physician and be considered in-network.

By Mr. Fitzpatrick's count, 68 percent or 2,397 of UPMC's 3,510 employed physicians would fall into that category, including 416 of its 828 primary care physicians, 77 of its 166 obstetrician- gynecologists and 86 of its 102 medical oncologists.

Mr. Wood's response: "We have no idea what Highmark is talking about or how they dreamed up that number. We have reached no agreement other than all UPMC-employed docs will be out of network except for services provided at sites specified in the mediated agreement. …

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