Physicians 'inundated' with questions after UPMC-Highmark breakthrough, broker says

While UPMC and Highmark ended their contentious dispute June 24 with a landmark 10-year contract, questions still remain about the details of the agreement, according to the Pittsburgh Post-Gazette.

Beginning July 1, many Pittsburgh-based Highmark members will have in-network access to Pittsburgh-based UPMC's hospitals and physicians. However, according to the Pittsburgh Post-Gazette, not all Highmark members will have full access to UPMC, including members of Highmark's fast-growing narrow network plan, Community Blue.

Under the agreement, Highmark members with Community Blue coverage will be treated in UPMC hospital emergency rooms at "affordable out-of-network" rates, according to Highmark. They won't have full access to UPMC providers like members with Highmark's broad access plans.

Highmark's explanation of the deal has led to widespread confusion among brokers and physicians, Dave Scott, vice president of broker ARMS Insurance Group, told the Pittsburgh Post-Gazette. "My phone has been blowing up. These doctors' offices are being inundated," he said.

After the deal was signed, Highmark President and CEO David Holmberg said June 24 the narrow network plans will include in-network access to Highmark subsidiary Allegheny Health Network in Pittsburgh and independent hospitals, while the broad access plans, which cost more, will include UPMC facilities.

A UPMC spokesperson told the Pittsburgh Post-Gazette Mr. Holmberg's comments didn't address a key part of the agreement, which will allow Highmark members to pay the same to use UPMC services as AHN. The discrepancies may be an indication that some terms of the agreement have yet to be hammered out, according to the report.

Read more here.

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