UPMC and Highmark agreed to a new contract ensuring patient access. What’s next? | News | Pittsburgh | Pittsburgh City Paper

UPMC and Highmark agreed to a new contract ensuring patient access. What’s next?

Today, feuding health-care giants UPMC and Highmark agreed to a 10-year contract that ensures Highmark patients have in-network access to UPMC doctors and hospitals.

A longtime conflict between the two nonprofits had led to a split that meant most of the patients with Highmark health insurance would have to pay out-of-network costs to UPMC doctors and hospitals, despite the fact that some Highmark patients had UPMC doctors for years and UPMC hospitals were often their most convenient option.

Earlier this year, Pennsylvania Attorney General Josh Shapiro sued UPMC in the hopes of getting them to accept Highmark patients. Shapiro announced the contract today and was elated with the results. He tweeted the agreement was a “momentous achievement.”

Shapiro also announced that his office has withdrawn its lawsuit against UPMC.

But UPMC is not out of hot water. State Rep. Dan Frankel (D-Squirrel Hill) applauded the agreement reached between UPMC and Highmark, but encouraged the state legislature to support his Expanding Fair Access to Hospital Legislation package of bills that would ensure fair contracts between competing health-insurance providers.

The agreement signed between the health-care giants is for 10 years, and it is uncertain what would happen after that agreement expires in 2029.

“And, as we celebrate UPMC’s decision not to hold patients hostage to force an outcome that suits them, I again call on my colleagues to support my legislation to put some regulations in place so that hospital-insurance companies who get tax benefits like charities are also required to behave like charities,” says Frankel in a press release. “We cannot have this commonwealth’s families fearfully holding their breath every time a contract is up for negotiation.”
Shapiro’s now-dropped suit against UPMC sought to prove that UPMC, a nonprofit, was in violation of its charitable obligations in failing to accept Highmark patients.

But some are still questioning if UPMC is living up to its charitable obligations, even after the agreement was signed. Allegheny County Controller Chelsa Wagner also called on support for Frankel’s legislation, House Bills 1211 and 1213.

“While this agreement is a welcome development, we still need to finish the job with legislation that puts an end to all uncertainty, so that five or 10 years down the line, no entity can use our healthcare as a bargaining chip,” said Wagner in a press release.

She also called on a renewed effort to challenge UPMC's charitable mission in Allegheny County. Wagner is a critic of the tax-exempt status that large nonprofits like UPMC have in Allegheny County. These nonprofits are not required to pay county, city, or school district property taxes in the county. Wagner is hopeful that progress can be made in that area moving forward.

“Our residents deserve a charity that lives up to its title,” says Wagner. “Hopefully this agreement offers the first step in this journey.”

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