Consent Decree – Highmark vs. UPMC

As medical care advances and treatments increase, health care costs also increase. The purpose of health insurance is to help you pay for care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. 

Two of the best known health insurance providers in our area are Highmark and UPMC.  Most unfortunately, those two local health giants have been embroiled in a bitter feud for many years.

At issue now is the coming end of the “consent decree” between two health insurance giants.  Many people are now faced with an untenable decision.  Do I change my doctor?  Do I try to change my health insurance?  Can I keep my specialist?  Will I have to switch to an unfamiliar hospital?  And, why am I being forced to do this?

Well the answer appears to be it’s because these two billion dollar giants don’t get along.  And because they don’t/can’t/won’t get along, countless individuals, many of whom have developed decades-long relationships with their health providers, are now being forced by these billionaire healthcare insurers to dump their family doctors, primary care providers, specialists, hospitals and emergency rooms. 

Let’s examine this ridiculous history.  Or not. 

Not enough space to get into it here, but if you do a google search you’ll see articles the likes of:  “UPMC, Highmark continue their Medicare Advantage feud; Highmark vs. UPMC: ‘It’s been a mess’; PENNSYLVANIA PLAYERS: HIGHMARK AND UPMC CONTINUE TO BATTLE” and more. 

According to these articles, the problem has been around for years but reached a peak in 2014 when the contract between UPMC Hospitals and Highmark ended and UPMC announced it would no longer offer “in-network” access to UPMC doctors and hospitals to Highmark insurance customers.  The state came in and brokered a five-year consent decree that allowed access for Highmark members to UPMC physicians and hospitals.  That decree expires in June of 2019. 

One article* that sums up the feud nicely was written by Carolyn Johnson of the Washington Post:  “They could be mirror images of each other, flipped upside down. UPMC started out in the hospital business, then created its own health insurance plan and built a $20 billion-a-year enterprise. Highmark, which reported $18.2 billion in revenue last year, announced in 2011 that it would branch from insurance into hospitals.”

So what about you, me, our neighbors and friends, the constituents of the 49th Senatorial District and beyond?  What are we supposed to do now that the general practitioner we’ve been seeing for years has to be fired?  What about the knee specialist that my friend has been working with, but will no longer be able to perform his surgery and monitor his recovery.  And, the countless other scenarios? 

We’re talking about the individuals we trust with our lives.  Don’t misunderstand me, I know there is quality healthcare being provided on both sides.  What really angers me is that corporate health care executives are forcing my friend’s grandmother to find a new doctor after 55 years — someone she’s never laid eyes on before will now be administering her health care at a time when, presumably, her needs will increase. 

These insurance giants are forcing her to leave the physician who kept track of her health all these years, examined her newborns, watched them grow up, asked after her family and knew her medical history.  As she and all of us step into the unknown with different health providers, I ask myself these questions:  Why am I being forced to leave my physician or pay more or pay out-of-pocket?  How long will it take to be comfortable with a new office and demeanor?  How many other people are in the same boat and are as uncomfortable about it as I am?  And, how is it these insurance giants have no qualms about spending our money on a barrage of lawyers in order to force us to do this?

One final thought.  As our region is forced to pick sides for health care, and our anger grows, the other voice in the room grows.  The medical care for all voice.  So someday when the voters demand single-payer health care and the insurance providers are forced out of business, at least they will know when it started.

In closing, I encourage local residents to visit my website,, and my Facebook page,, to keep up to date with state government news – including the state budget — and learn more about state services and agencies.

Contact:          Matt Azeles        


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