By now, you probably have heard about the transition agreement that will allow western Pennsylvania health care giants UPMC and Highmark to part ways when their contract expires at the end of this year.
The consent decrees will ease much uncertainty about the split. But it doesn't do enough to help western Pennsylvania residents who are insured by Highmark but want to use UPMC facilities for their care.
I wanted UPMC and Highmark to put area residents first and end their feud. In fact, I was prepared to force these two companies to come to the bargaining table and remain there until they reached a deal.
Find out what's happening in North Hillsfor free with the latest updates from Patch.
House Bill 1965, which I co-sponsored, would enable the Pennsylvania insurance commissioner to force health insurers and large health systems back to the bargaining table. In the event that failure to reach an agreement would significantly disrupt access to medical care in the region, like the UPMC/Highmark dispute, the commissioner could force the parties into mediation and, if necessary, binding arbitration.
Unfortunately, the bill has sat in the Republican-controlled House Insurance Committee and appears to be dead.
Find out what's happening in North Hillsfor free with the latest updates from Patch.
So we are left with the transition agreement that was reached only after the attorney general and governor's offices intervened.
Under the agreement, a person being rushed to the hospital with a life-threatening illness or injury would not have to bypass a UPMC medical facility because it will not accept Highmark insurance under the agreement.
Other highlights include:
• All seniors in any existing Highmark plan will have access to UPMC providers on an in-network basis. This includes seniors who have Medicare Advantage plans, Medigap Blue, Signature 65 and other group "carve out" plans.
• Allowing people who are receiving treatment for any illness to have continuity of care as long as the patient and doctor deem necessary.
• Those receiving oncology treatment will maintain in-network access, and for illnesses and complications resulting from cancer treatment.
• Any existing UPMC patient who is a Highmark member and received in-network care from UPMC in 2014 can continue to receive care from that same physician in 2015, if they cannot find an alternative physician in their area.
This deal is helpful to western Pennsylvania. But I had hoped we could have reached a better solution.
