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Highmark-UPMC Relationship Ends With Exceptions

PITTSBURGH (KDKA) -- Jan. 1 starts a new relationship between Highmark's insurance customers and UPMC, and it's sometimes hard to sort out what it all means.

"We understand, across the board, insurance can be a confusing thing. There are layers. It's difficult to comprehend," Highmark spokesman Doug Braunsdorf told KDKA money editor Jon Delano on Wednesday.

Here's the bottom line.

"On Jan. 1 if a person is still a Highmark subscriber, that means they would be considered out of a network for UPMC doctors and hospitals in the five-county region around Allegheny County -- with a number of exceptions," said Paul Wood, UPMC spokesman.

It's the exceptions that make this so confusing.

"Many people are going to find they will continue to have that access that they've had and they continue to want to have," said Braunsdorf.

So, first, if you are on Medicare, Medicaid, or CHIP, you can still use UPMC at the lower in-network rate.

Second, emergency room service is always available to Highmark customers.

Third, Children's Hospital and Western Psych are open to Highmark insureds, along with UPMC Mercy until June.

Fourth, if you currently see a UPMC doctor for an on-going condition, the continuity of care exception allows you to stay where you are.

As for others, says Wood, "Then, it's going to be very difficult to see a UPMC physician or go to a UPMC facility on an in-network basis in 2015."

The state's insurance department says it will help Highmark customers sort it all out.

"It's very difficult to provide guidance for every specific instance," said Rosanne Placey, a spokeswoman with the Insurance Department. "That's why we've established this website – -- to provide general guidance and a place for people to go to ask their questions."

And both Highmark and UPMC will answer your questions, too.

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