Lack of UPMC-Highmark contract concerns many

Source: Erie Times-News, Pa.迷你倉Jan. 19--Highmark's and UPMC's failure to extend UPMC Hamot's provider contract with the Pittsburgh-based health insurer is frustrating local patients, physicians, employers and insurance agents.Hamot's current contract with Highmark ends Dec. 31. If an extension is not reached, those with Highmark insurance will not have access to Hamot or its physicians, except for emergency care, starting in 2015."This has really shaken up the marketplace," said Jeff Evans Jr., of Employee Benefits Resources, 4740 Peach St. "We are all really worried that this will cause a lot of disruption."It's the latest skirmish in a battle between two health-care giants that started in 2011 when Highmark announced it was buying the West Penn Allegheny Health System. Highmark later bought Saint Vincent Hospital and created the Allegheny Health Network, an integrated delivery system.UPMC officials have said they would not negotiate a new provider's contract with Highmark because they viewed its Allegheny Health Network as a competitor. But in July, UPMC board members told Highmark they were interested in extending Hamot's contract, but not the contracts of its hospitals in Allegheny County.Hamot President James Fiorenzo said the two sides discussed a contract through late October, providing copies of e-mails that suggest at least one high-ranking Highmark official expected Hamot's contract would be extended past 2014.Highmark spokesman Aaron Billger said negotiations consisted only of UPMC proposing a nearly 50 percent increase in Hamot's reimbursement. He also said Highmark officials who wrote e-mails about reaching a contract with Hamot meant that it would be reached as part of a provider's contract with all UPMC hospitals."Our position hasn't changed," Billger said. "A systemwide contract with UPMC is in the best interest of the entire community. The problem with a stand-alone contract is that it raises a lot of continuity-of-care issues. What would happen if Hamot needs to transfer a patient to another UPMC hospital? Is it out of network?"No negotiations involving Hamot are scheduled between Highmark and UPMC, said Billger and Fiorenzo.Though Hself storagemot's current contract runs through the end of 2014, time is already limited for employers whose insurance contracts renew in July, with negotiations expected to begin in April.Some of these employers and insurance agents say they feel they have been misled by Highmark representatives, Evans said."We were being told -- even up to the end of 2013 and into 2014 -- that Hamot would be an exception to the whole dispute," Evans said. "There were a lot of employers who renewed with Highmark for Jan. 1 on the belief that Hamot would be an exception."Billger said he couldn't explain what Highmark representatives told Evans, only that Highmark's message has been consistent for more than two years about seeking a contract with all UPMC hospitals.If a contract extension is not soon reached, Hamot will begin "educating" its patients through the media and direct mail about how they can continue to be treated at the hospital and by its physicians, Fiorenzo said."We will begin offering information about alternative choices," Fiorenzo said. "Access to Hamot would be through other insurances we accept, including UPMC Health Plan."Highmark hopes the state legislature will help force the two sides to reach an agreement, Billger said.Two bills currently in a state House committee would require integrated delivery systems like UPMC and Allegheny Health Network to contract with any willing health insurer.A number of constituents with Highmark insurance have complained to state Rep. Curt Sonney, R-4th Dist., of Harborcreek Township, about the possibility of losing access to Hamot."Obviously having these bills is a tremendous amount of pressure on Highmark and UPMC to reach some sort of deal, even though the bills haven't run yet," said Sonney, a co-sponsor of both bills. "It's hard to determine if these bills will become law. I think the closer we get to the end of the year, the more likely these bills will become law."DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.Copyright: ___ (c)2014 the Erie Times-News (Erie, Pa.) Visit the Erie Times-News (Erie, Pa.) at .GoErie.com Distributed by MCT Information Services迷利倉