UPMC, Highmark breakup making it hard to do enrollment for seniors

A state-brokered agreement between Pittsburgh health giants the University of Pittsburgh Medical Center and Highmark Health ends June 30. (Getty/Joecho-16)

This week marks the end of the enrollment period for Medicare recipients in Pennsylvania. But this sign-up season has been a bit of a trick for seniors in the western part of the state stuck in the middle of the breakup between two of the region's largest health providers. 

A state-brokered agreement between the University of Pittsburgh Medical Center and Highmark Health—both of which serve as providers and insurers—ends June 30.

That means starting in July, seniors who have selected Highmark Medicare Advantage plans will no longer have in-network access to UPMC hospitals and most UPMC doctors. (Highmark has said it will cover extra out-of-network costs for the second half of the year so patients won't have to pay more to see UPMC providers in 2019.)  

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The protracted and "messy divorce" battle (as it was dubbed by the Pittsburgh Post-Gazette) garnered a notable rebuke from the Post-Gazette's editorial board this week, which also called for greater scrutiny from the state attorney general and insurance regulators. "The combatants cannot police themselves and long ago, in the war to destroy each other, lost sight of the sick people who need them," they wrote. 

RELATED: Highmark vs. UPMC: The saga continues

They have also received heavy criticism from state leaders, including from an outgoing Republican lawmaker, who called on his colleagues this week to do a better job of confronting Highmark and UPMC, the Pittsburgh Business Times reported.    

What's the back story? As the Washington Post reported earlier this year, things started heating up when Highmark decided to get into the hospital business back in 2011. UPMC, which was already in the insurance business, threatened to stop accepting Highmark insurance. State agreements have smoothed things over since, but it hasn't been pretty. As Judge Dan Pellegrini said in a 2014 court hearing regarding the dispute between the Pittsburgh health giants: "It's like fourth grade."

For his part, Pennsylvania Attorney General Josh Shapiro confirmed to the Post-Gazette that his office is closely watching the situation and said he was ensuring compliance with laws governing charitable care and their tax-exempt status. In addition, HHS Secretary Alex Azar has confirmed that federal regulators are also monitoring the situation.

RELATED: Penn State Health, Highmark Health sign $1B value-based care network deal

Allegheny Health Network, operated by Highmark, announced last month that it would put $1 billion toward building a new state-of-the-art hospital and "neighborhood" hospitals and renovating existing facilities, a project expected to create 800 new healthcare jobs in the Pittsburgh region and a 160-bed hospital in the city's Wexford suburb. Highmark inked a deal with Geisinger Health System to create a new community-based clinical network last year and signed a $1 billion value-based care network deal with Penn State Health.

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