Shapiro keeps tabs on Highmark-UPMC split

on actions he might take, if any, but offered that “it is something we are paying close attention to and I would simply say, ‘Stay tuned on that.’”

In less than nine months, UPMC and Highmark will end their long-standing contractual relationship during which both Pittsburgh health giants prospered.

Disagreements on the terms of renewing that contract in 2011 led to an estrangement that has unfolded over the past seven years, with state officials intervening and getting both sides to sign the five-year consent decrees in 2014.

In some respects, the evolutionary track that UPMC and Highmark have both taken — combining a provider network of physicians and hospitals, as well as a strong insurance arm — is part of a nationwide trend.

“Vertical integration itself is not a concern. It’s the way in which it has been carried out in certain markets,” Mr. Shapiro said Monday, and how that impacts consumers’ access to quality, affordable care.

The consent decrees between Highmark and UPMC were meant to settle how and when the two health giants would go their separate ways next year.

But questions about access moved to the forefront again Oct. 1, the first day that insurance companies could disclose their Medicare plan offerings for 2019.

With the end of Highmark Medicare Advantage members’ in-network access to UPMC slated for June 30, 2019, Highmark officials said they would offer an enhanced out-of-network benefit for Freedom Blue and Security Blue members that would allow them to seek care at UPMC hospitals at no additional out-of-pocket cost.

Historically, that process would involve provider UPMC billing Highmark, which would settle the account with the patient.

Without a contractual relationship, UPMC officials say they would have no guarantee of getting paid in that scenario. For that reason, they intend to require members of Highmark and other out-of-network insurers to pay for services first, based on the Medicare fee schedule.

Such a policy, some say, could effectively deny access to UPMC for those who cannot afford to pay the fee up front.