UPMC, which has been seeking to sever ties with insurance giant Highmark, reached an agreement with the health plan Friday on the terms of continuing care for Highmark patients currently being treated at its facilities.
The Pittsburgh-based health has been trying to end its relationship with Highmark ever since the insurer's 2013 acquisition of West Penn Allegheny Health System, which significantly heated up competition in the western Pennsylvania market. But UPMC has faced resistance from local political leaders as well as Highmark itself.
The two parties last year entered into a consent decree with state officials, including then-Gov. Tom Corbett, that guaranteed Highmark members access to certain UPMC services, including oncology, behavioral health specialists and pediatrics for several years.
Friday's settlement agreement, which will extend through June 30, 2019, focuses on the application of the continuity of care provision in the consent decree, UPMC and Highmark said in a joint statement.
“This confirms that decisions regarding continuity of care are to be made by the patient and his or her treating physician, subject to appeal by Highmark to the Pennsylvania Department of Health,” said UPMC spokesman Paul Wood in an e-mail.
The settlement focuses on patients with chronic conditions who were treated at UPMC between 2013 and 2015, and excludes routine preventative care and wellness services. Patients with a confirmed pregnancy prior to Dec. 31, 2015 can also continue services with UPMC through the postpartum period.
Patients who have not been seen since 2012 are unlikely to be considered as being under a continuing course of treatment, the settlement states.
The agreement also outlines the process for resolving disputes over patient qualification to continue care under in-network rates.