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UPMC Pinnacle, Highmark in spat over Highmark ACA plan

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Highmark is not including most UPMC Pinnacle providers in the individual health plan it is selling on the Obamacare marketplace, a change that UPMC Pinnacle said in a news release is causing confusion and frustration among some of its patients.

Two UPMC Pinnacle providers will remain in the network in 2018 for the Highmark health plan, called My Direct Blue EPO:

  • UPMC Pinnacle Carlisle, formerly Carlisle Regional Medical Center
  • AllBetterCare, an operator of urgent-care centers that affiliated with UMPC Pinnacle earlier this year

"Except for emergency and out-of-area urgent care, Highmark My Direct Blue EPO members will receive no coverage for care received at any other UPMC Pinnacle facility or providers in 2018," UMPC Pinnacle said in its press release.

The release noted that all UPMC Pinnacle providers and facilities are in the network for Affordable Care Act plans sold by Capital BlueCross.

"UPMC Pinnacle patients wanting to continue care with UPMC Pinnacle should consider Capital BlueCross marketplace plans," said the release.

Efforts to reach a UPMC Pinnacle spokesperson on Thursday afternoon were not immediately successful.

A Highmark spokesman said in an email that UPMC Pinnacle was asked to be in the network but would not negotiate a discount that made the coverage affordable to consumers shopping under the Affordable Care Act, also known as Obamacare.

UPMC Pinnacle providers remain in the network for Highmark’s commercial products, including plans for large and small groups, wrote the spokesman, Leilyn Perri.

Perri noted the difficulties Highmark and other insurers have encountered in covering people enrolled under the ACA. A number of insurers have left the market altogether, while others, including Highmark, have endured financial losses.

"Insurers have to make difficult choices – sometimes that means not all providers will be in an insurer’s products," Perri wrote.

"All are our members are certainly welcome and encouraged to call customer service or go into a Highmark Direct store if they need additional information about their product options," he added.

Consumers have until Dec. 15 to choose a plan on the ACA marketplace for coverage in 2018.


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Joel Berg

Joel Berg

Joel Berg is editor of the Central Penn Business Journal. Born in Philadelphia, raised in Northern Virginia and now living in York, he's a graduate of Franklin & Marshall College and the University of Maryland. Have a question or story idea? Email him at Follow him on Twitter, @JoelBYorkPa.

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vince November 17, 2017 11:06 am

Looks like the sad truth is that UPMC's expansion eastward means that the blood feud between UPMC and Highmark might be traveling east as well.

Ken November 17, 2017 9:01 am

All of our politician should be ashamed of themselves. All this is doing is driving small business owners out of business. I got a 41% increase for my individual plan and my terms and conditions got a lot worse. This cannot continue.

JJ November 17, 2017 8:39 am


Callous, greedy, monopolizing? How about governments attempts at providing massively discounted healthcare to most on the backs of the few does not add up. So an insurance company has to pull back? They'll have to pull back a whole lot more to keep propping up this shell game. Don't blame the hospital. They aren't hiking costs, Highmark is cutting ebenfits. And NEITHER is to blame. Well-meaning Liberal welfare state handouts are to blame.

Chritopher November 16, 2017 5:49 pm

Why am I not surprised? We have seen the same callous, greedy and monopolizing UPMC playbook before.