UPMC Offers Fix for Community Blue So Subscribers Can Continue to Access UPMC’s World-Class Care; Begins Transition to Expiration of Highmark Contract in 2014

By Paul Wood

In a letter today to the House Democratic Policy Committee, UPMC offered a solution to address concerns that have been raised about  Highmark's Community Blue product and the fallout Highmark created when it misled subscribers about Community Blue’s features.  This solution would also smooth the transition to the Dec. 31, 2014, expiration of the current Highmark-UPMC contract.

Community Blue has largely failed in the insurance market specifically because it was designed as a select network product that did not offer the vast majority of UPMC’s world-renowned hospitals and physicians.  Highmark also prohibited UPMC from "balance billing" patients, which foreclosed Community Blue subscribers from paying UPMC more to obtain out-of-network services. Fortunately, when the Highmark-UPMC contract expires in 2014, so will this unique and outdated prohibition of out-of-network access with the option for self-pay.

UPMC recognizes the confusion and frustration experienced by a handful of Highmark's Community Blue subscribers (coincidentally, almost all of them Highmark-WPAHS's own employees) seeking access to out-of-network UPMC services.  Therefore, instead of waiting for the expiration of its contract with Highmark, UPMC is prepared to immediately convert UPMC’s out-of-network component of Community Blue to the common method used by all insurers, including Highmark in central Pennsylvania. If Highmark agrees to eliminate its prohibition on UPMC's ability to balance bill Community Blue subscribers, UPMC will immediately provide those subscribers with out-of-network access to UPMC services.  Under this proposal, UPMC will employ the well-established reimbursement method used by every other insurer and healthcare provider:  UPMC would determine the out-of-network charges to be billed directly to the Community Blue subscriber and Highmark would determine the amount it will reimburse to the subscriber.   

The sooner the community begins the transition to the end of the Highmark-UPMC contract in 19 months, the more time Highmark subscribers will have to adjust and make the important decisions to preserve access to their current physicians and hospitals. Along with this change to resolve Community Blue's outdated prohibition of balance-billing patients who want to secure out-of-network services, UPMC is prepared to work with Highmark in other ways to ease and accelerate the transition contemplated for and facilitated by the 2012 mediated agreement overseen by Governor Corbett.