Wolf Administration Announces Consumer Protection as Top Priority in Enforcement of Highmark/UPMC Consent Decree

HARRISBURG, Pa., March 5, 2015 /PRNewswire-USNewswire/ -- Today, Acting Insurance Commissioner Teresa Miller and Acting Health Secretary Karen Murphy outlined their departments' intent to enforce key consumer protection provisions in the consent decrees signed last year by Highmark and UPMC.

"My administration will take steps to protect consumers and ensure care and coverage," said Governor Tom Wolf. "I have directed my Insurance Commissioner and my Health Secretary to take action to protect consumers."

"As soon as he took office, Governor Wolf directed us to ensure patients covered by Highmark plans can continue to be able to receive care from their UPMC providers under the conditions outlined in the consent decrees," Miller said. "I am making it clear today that I intend to enforce these provisions, as agreed to by both parties, for the protection of Pennsylvania citizens."

Following the 2013 acquisition of West Penn Allegheny Health System by Highmark, provider contract talks between the two parties broke down. In an attempt to provide protection for consumers during the transition, Highmark and UPMC signed consent decrees in June 2014 with the Insurance Department, Department of Health, and Office of Attorney General, spelling out how Highmark customers would get care from UPMC providers.

"Unfortunately, statements by both Highmark and UPMC have led to confusion among patients and their providers about both health care coverage and cost," Murphy said. "We will do everything in our power to enforce the consumer protections promised to patients by both Highmark and UPMC."

"The Wolf Administration is adamant that seniors, vulnerable citizens, and others currently receiving treatment have continuing care from the doctors they know and trust," Miller continued. "We are hoping for cooperation from all parties to make sure this happens."

The Wolf Administration's positions on key consumer protection provisions of the Highmark/UPMC consent decrees include:

• All Highmark members in a "continuing course of treatment" with a UPMC provider can continue to receive care on an in-network basis, at in-network rates, through June 30, 2019.
• The decision on whether a Highmark member who has received care prior to January 1, 2015, can continue to receive care from a UPMC provider for an ongoing medical condition is made by the patient, in consultation with his or her treating physician, whether independent or UPMC employed.

Specific protections for cancer patients in the agreement include:

• Highmark members will have in-network access to all UPMC services, facilities, doctors, and joint ventures for oncology and related illnesses or complications resulting from cancer treatment.
• This care includes, but is not limited to, endocrinology, orthopedics, and cardiology when a doctor determines an individual should be treated at UPMC and the patient agrees.
• Highmark members who are cancer patients can work with their physicians to determine the best provider for treatment.

Provisions concerning seniors and other more vulnerable citizens include:

• Seniors 65 or older who are eligible for or covered by Medicare, Medigap, or a Highmark Medicare Advantage plan, except Community Blue Medicare HMO, will have access to UPMC providers on an in-network basis.
• Other individuals covered under Medicaid and CHIP will also continue to have access to UPMC providers on an in-network basis.

Consumers who have concerns about their coverage, need assistance, or wish to file a complaint with the Insurance Department should contact the Pennsylvania Insurance Department at 1-877-881-6388 or visit www.insurance.pa.gov.

MEDIA CONTACT: Ron Ruman, Insurance Department, 717-787-3289
Holli Senior, Department of Health, 717-787-1783

 

SOURCE Pennsylvania Department of Insurance; Pennsylvania Department of Health

Related Links

http://www.state.pa.us