The Tribune Democrat, Johnstown, PA

April 5, 2014

Insurance spat will not be felt here, officials say

Randy Griffith

JOHNSTOWN — As UPMC and Highmark/West Penn Allegheny continue a high-stakes standoff over in-network insurance coverage in Greater Pittsburgh, leaders from both sides say patients who use hospitals in this area will not be caught in the crossfire.

“Simply put, the Highmark-UPMC contract expiration does not affect communities where UPMC is a sole provider, such as Altoona and Bedford,” spokeswoman Susan Manko said in a statement.

UPMC leaders insist they will no longer accept Highmark insurance at its Pittsburgh-area hospitals after Dec. 31.

“UPMC cannot, in keeping with its central clinical and academic mission, its duty to protect and preserve its charitable assets, and its obligations to the communities it serves, enter into any extension of the existing commercial contracts, or any new commercial contracts, providing Highmark with in-network access to any current UPMC hospitals or physicians in Southwestern Pennsylvania,” the UPMC board announced in June.

There are a few exceptions. They include Children’s Hospital of Pittsburgh of UPMC, Western Psychiatric Institute and Clinic, UPMC Northwest in Venango County, UPMC Bedford Memorial and UPMC Altoona.

The exceptions represent areas where UPMC is not in direct competition with Highmark-owned West Penn Allegheny Health System facilities, Manko noted, adding that it will benefit patients to set up competition in the Pittsburgh market.

“Southwestern Pennsylvania, conversely, is a highly competitive, over-bedded, major population center that will greatly benefit from the increased insurance competition, abundant choice and premium reductions resulting from no extension of the contract between Highmark and UPMC,” Manko said.

Conemaugh Health System’s proposed acquisition by Duke LifePoint Health System should not draw the Johnstown system into the fray, both sides agreed.

 “We fully expect to continue our long-term partnership with Conemaugh and have a contract that provides in-network access for Highmark members,” Highmark spokesman Aaron Billger said.

Highmark is also negotiating contracts with both UPMC Bedford Memorial and UPMC Altoona, Billger confirmed.

“Attorney General Kathleen Kane, as part of the conditions for acquistion, said UPMC needed to have a contract with Highmark negotiated,” Billger said.

Bedford’s Highmark contract was part of an agreement between UPMC and Highmark mediated in 2012 by Gov. Tom Corbett.

Conemaugh’s independence from either Pittsburgh giant makes it important not only for UPMC and Highmark, but for other insurance companies looking to expand membership in western Pennsylvania, said Scott Becker, president and CEO.

“We will be insurance agnostic,” Becker said in a recent interview. “We will play with all comers. They need us and we need them.”

Patients who are referred to Pittsburgh-area physicians and hospitals, or who prefer to seek care in the larger city, should check with providers to see if they will pay out-of-network co-payments after Jan. 1.

Randy Griffith covers health care for The Tribune-Democrat. Follow him on Twitter at