Hospitals slam Highmark for limited network plan


As insurers continue launching health plans built around limited networks, some hospitals are fighting back after being excluded from these networks.

Highmark is facing such pushback in a very public forum as Geisinger Health System, based in Danville, Pa., has accused the state's largest insurer of forcing patients away from its hospitals. Highmark's Community Blue health plan requires members to pay more for Geisinger's three hospitals and physician group than other providers, reported the Pittsburgh Tribune-Review

"It's inappropriate, inconvenient, insensitive and simply wrong to force our neighbors to leave home to seek the care they desperately need," Geisinger CEO Glenn Steele wrote in a print ad. "It's bad for you and your family. And it's bad for central Pennsylvania."

Community Blue categorizes providers into three cost-based tiers--enhanced, standard and out-of-network. Providers in the standard and out-of-network tiers result in higher copays and other out-of-pocket costs, the Patriot-News reported.

But Steele claimed Highmark's marketing materials for the Community Blue plan describe Geisinger as less valuable than other providers. "Under the guise of promoting quality and value, it appears that Highmark is penalizing patients who want to obtain advanced and complex medical care locally," he wrote, according to the Pittsburgh Business Times.

Highmark fought back, explaining its Community Blue plan merely seeks to "give people choice," Highmark spokesman Leilyn Perri said. What's more, by designating Geisinger as a standard tier provider, Highmark isn't attacking its quality of care. "The hospitals deliver excellent care, but they are in the standard tier because they cost more," he added.

To learn more:
- read the Pittsburgh Tribune-Review article
- see the Pittsburgh Business Times article
- check out the Patriot-News article

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