PITTSBURGH (KDKA) -- Most Highmark subscribers will soon lose low-cost access to UPMC in a consent agreement Highmark agreed to.
"It's almost as if UPMC won. Did you cave to UPMC?" KDKA money editor Jon Delano asked Highmark's new CEO on Friday morning.
"You know what -- we don't believe we caved," said David Holmberg.
Highmark's Holmberg answered tough questions about this region's largest health insurer that also offers health care through its Allegheny Health Network.
"We believe that it's the right of the individuals in this region to choose where their care comes from, the kind of care they receive, and the price they pay for it," said Holmberg. "And we've always been committed to that. Unfortunately, that wasn't an option that was available to us."
So come January, most healthy folks insured by Highmark won't use UPMC -- except those in the middle of critical care.
"It's really between your doctor and you as to whether or not you continue forward with that care or you transfer to another doctor. We do not believe that Highmark or anyone else has the right to interfere with that," noted Holmberg.
In that consent agreement, both UPMC and Highmark pledged to give seniors access to UPMC.
But recently Highmark offered a Medicare Advantage plan that had no access to UPMC.
The government and UPMC cried foul, and it did seem to contradict Holmberg's earlier words last July on the Sunday Business Page.
Holmberg: "We thought it was very, very important that we protected all of the seniors."
Delano: "So all the seniors are taken care of? They can go to UPMC facilities with in-network costs?"
Holmberg: "That's correct."
On Friday, Holmberg responded to his earlier comments.
Delano: "When you said to me that there was access to seniors, did you lie to me?"
Holmberg: "Absolutely not."
Holmberg says Highmark still offers seniors a plan that includes UPMC, but now has a cheaper product that does not.
A court on Thursday said Highmark did not violate the consent decree.
"It gives seniors the opportunity for choice, and Highmark is totally committed to doing that."
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