Dive Brief:
- Women who have Highmark Health coverage and learned of their pregnancy in 2014 will be able to deliver at University of Pittsburgh Medical Center's Magee-Womens Hospital, according to an agreement announced last week by Pennsylvania Gov. Tom Wolf.
- Previously, the only women who would have been eligible for in-network Magee delivery in 2015 were those who had already seen a UPMC physician and were actively receiving a "course of treatment" related to their pregnancy. Those seeing a physician affiliated with another hospital—even a physician with admitting privileges at Magee—would be locked out, per Highmark's interpretation of this summer's consent degree that governed its separation from UPMC.
- The governor's announcement is chiefly aimed at women seeing UPMC-owned OB/GYNs and independent OB/GYNs, however, it also could apply to women who have OB/GYNs affiliated with other hospital networks and want to deliver at Magee-Womens Hospital.
Dive Insight:
While the fallout from the UPMC-Highmark breakup continues, at least patients are protected from the shift in coverage rules. As of Jan. 1, the two large health organizations are learning to work together under the new operating arrangement now that the long-term, full-access contract between the insurer and the hospital system has expired. Still, the continued squabbling and damage to Highmark's reputation in the fallout underscores the riskiness of hospital-insurer integration.