UPDATE @ 8:45 a.m. Tuesday: Penn State has set up a website featuring information and frequently asked questions about the Highmark-Geisinger situation. The website is available right here.
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Penn State employees and their dependents insured through the university may lose access to in-network coverage by Geisinger Health System health-care providers on Jan. 1, the university warned.
Highmark Blue Shield, which administers the university’s health insurance, has not yet settled an agreement to continue Geisinger’s participation as a recognized, in-network care provider for Highmark clients, Penn State reported Friday. The university said it learned of the situation last week.
‘With the current (Highmark-Geisinger) agreement due to expire at the end of December, Highmark is required by the Pennsylvania Insurance Department to notify its members of the potential of a network provider discontinuing its network participation,’ Penn State wrote in a news release. ‘Termination of the contract is not always the actual result, but these regulations are meant to allow time for patients to find other services if needed.’
The apparent impasse would affect not only those insured through Penn State, but also workers covered by Highmark at other employers in Pennsylvania. State-required notification letters are expected to be sent to Highmark customers statewide within days, according to Penn State.
Those letters will be sent to those who ‘currently seek services from Geisinger,’ the university reported.
Reached by e-mail, Penn State spokeswoman Lisa Powers said the university has ‘no idea how close (Highmark and Geisinger) may be to an agreement, but we certainly hope it will be soon as the Dec. 31 deadline looms.’
She didn’t have exact numbers showing how many university employees and dependents are using Geisinger services. Still, ‘it is a substantial number of employees in the Centre Region,’ Powers wrote.
‘We know this because Penn State’s (spending) on Geisinger health services amounts to one third of our $250 million annual health-care outlay,’ she went on.
If Highmark and Geisinger don’t reach a new agreement by Dec. 31, Powers noted, university employees and dependents may still seek care from Geisinger providers. But ‘they will just have to pay at the higher out-of-network rate,’ not the discounted rates available at providers who are in Highmark’s network.
The apparent Highmark-Geisinger impasse is a surprise to the university, Powers wrote. When employees were choosing health-care options in November, she said, Penn State ‘fully expected Geisinger to be a part of Highmark’s network.
‘However, if Geisinger does not participate, that will be Geisinger’s decision,’ Powers went on. She indicated that Highmark is ‘looking for an agreement that is fair and appropriate for its customers and the community, and they don’t believe they’ve reached that point.’
‘Obviously, costs are going to play a critical role’ in the Highmark-Geisinger discussions, Powers wrote. ‘ … Health-care costs are ballooning, and there needs to be some compromise.’
Reached Monday morning, Geisinger spokeswoman Kim Aboud confirmed that negotiations with Highmark are ongoing.
‘We are hopeful that we will be able to come to an agreement,’ Aboud said.
Beyond the Geisinger system, Powers indicated that Penn State Hershey doctors have a growing presence in the Centre Region, with two additional Penn State-affiliated specialty sites set to open in January. One will be at the Colonnade in Patton Township; the other, along the Benner Pike.
University employees and dependents also can find in-network coverage through Mount Nittany Medical Center physicians and independent doctors and specialists, Powers wrote.
‘For employees who may currently be involved in treatment for a serious medical condition requiring follow-up care, such as a newly diagnosed cancer, a recent heart attack or a mental-health issue, we have set up a Transition of Care plan with Highmark,’ she wrote.
That plan ‘would allow a member to continue to access Geisinger Medical Center and have services paid at the in-network level of benefits after Jan. 1,’ Powers went on. ‘We are hoping that (contingency arrangement) won’t be necessary.’
Penn State is encouraging people with specific questions to call Highmark at (800) 914-4384. Benefits specialists at the university also are available to field inquiries and can be reached via e-mail at benefits@psu.edu.
Other Penn State coverage
