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Highmark's transition plan to Pennsylvania Insurance Department clarifies network and consumer protections and launches new member resources in advance of UPMC contract termination

With the goal of reducing customer confusion about its members' access to UPMC facilities and doctors, Highmark Inc.'s final transition plan today was posted on the Pennsylvania Insurance Department website and will be implemented immediately by Highmark.  

The plan clearly spells out Highmark's provider network and member protections in place when UPMC terminates many of its contracts with Highmark on December 31, 2014. The plan also provides insight into the various communication tools Highmark will use to assist members as they navigate the new health care landscape in Western Pennsylvania. The plan is accessible through the Insurance Department's website, insurance.pa.gov, by clicking on the Blues plan icon, or at StayInformed.pa.gov.

The transition plan outlines the process for safeguarding consumers' health care, minimizing patient disruption and maintaining affordable access to high-quality health care for Highmark members. It centers on Highmark's provider network, member access to care, continuity of care and communications to customers.

"Highmark's transition plan focuses on the most important part of health care – the patient," said Highmark Health Plan President Deborah Rice-Johnson (pictured). "Everyone involved in this situation needs to be focused on the people who will be impacted in Western Pennsylvania. The plan incorporates several of the provisions of the consent decrees agreed upon by UPMC and Highmark in late June with the help of Governor Corbett and Attorney General Kane, which provide our members with protections that address such important issues as the patient-provider relationship, affordable access to emergency care and in-network access to cancer care at all UPMC providers and facilities."

Specifically, those patient protections include continued in-network access for emergency care for Highmark members at all UPMC facilities. Additionally, Highmark members will continue to have in-network access to more than 80 percent of UPMC-owned physicians when they are performing services at UPMC hospitals outside the five-county Pittsburgh region or at numerous community hospitals in the greater Pittsburghservice area (AlleghenyBeaverButlerWashington and Westmoreland counties).

"This means Highmark's network will include all UPMC-owned oncologists, pediatricians, behavioral health specialists and emergency medicine physicians," said Rice-Johnson, "and any other UPMC physicians working at or on behalf of any facility that is considered in network for Highmark products." 

The transition plan outlines Highmark's strength in continuing to seamlessly serve members' needs. Key elements addressed include:

  • Provider Network:  Highmark has assessed the ability of its provider networks to demonstrate that it has the capacity necessary to serve members in its broad and tiered-network products. Highmark will continue to meet or exceed all state and federal network adequacy requirements. Highmark has launched a website – YourNetwork2015.com – where members can see which doctors and hospitals are expected to be in Highmark's network for 2015.
  • Affordable Access:  Highmark members will continue to have in-network access to an extensive network of providers, including the eight hospitals in Allegheny Health Network, more than 40 independent community hospitals and more than 9,000 independent or community hospital-owned physicians.
  • Continuation of Care:  Highmark will coordinate continuation of care for members currently being treated by UPMC providers and for members transitioning from UPMC providers. For new members or for members needing transition from UPMC providers, Highmark is prepared to assist and has created a number of tools and other resources that will allow members to seamlessly transition to non-UPMC facilities and physicians.
  • Communication:  Highmark has developed an action plan and timeline for appropriate communications to clients and members in an effort to keep them informed regarding provider access, choice and changes in cost or scope of coverage issues with UPMC providers. In order to reduce potential member confusion, Highmark also will work with UPMC to develop a process for the prompt resolution of any member issues that result from the transition of providers.

"The variety of products we offer means employers and individuals have a range of access and cost options," said Rice-Johnson. "That includes traditional broad network plans, as well as tiered-benefit plans. Our Community Blue product continues to grow, and we are planning to offer additional Community Blue products in 2015 for other membership segments, including a new tiered-benefit product that will provide the ability to access UPMC on an out-of-network basis at a higher cost share with the member's liability capped at 60 percent of the UPMC charges."

According to Rice-Johnson, these provider networks position Highmark to succeed in competing for customer business by providing the value and quality of services at Allegheny Health Network and community hospitals while maintaining selective access to UPMC.

Highmark members will retain full, in-network access to all UPMC facilities and physicians outside the five-county Pittsburgh region. These exception hospitals include UPMC Bedford, UPMC Northwest, UPMC Hamot and its affiliate Kane Community Hospital, UPMC Altoona, UPMC Horizon and any facilities acquired by UPMC in the future. Additionally, Western Psychiatric Institute and Clinic, Children's Hospital of Pittsburghof UPMC and UPMC Mercy will remain in network.

About Highmark Inc.

Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in PennsylvaniaDelaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.


SOURCE Highmark Inc.



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