Jefferson Health notified insurance brokers that it could go out of network with Highmark on Jan. 1
Highmark is the second Blue Cross company Jefferson Health has taken on in recent weeks. The nonprofit also said it will stop accepting Independence Blue Cross if it can’t get higher rates.
Jefferson Health notified insurance brokers Tuesday that its Philadelphia and Lehigh Valley facilities could stop accepting Highmark insurance on Jan. 1 if the Pittsburgh-based insurer doesn’t agreed to higher payments.
That means Jefferson, the largest health system in the Philadelphia area and owner of Lehigh Valley Health Network in Northeastern Pennsylvania, is in high-stakes negotiations with Pennsylvania’s two biggest Blue Cross Blue Shield companies.
Last month, Jefferson notified patients with Independence Blue Cross insurance that it will go out of network with the Philadelphia region’s largest insurer if it doesn’t get substantially higher rates. Jefferson said IBX pays it 40% less than the national average.
Jefferson’s notice Tuesday did not address specifics on rates, but said that “Highmark has not agreed to rates that fairly support the care provided by Jefferson Health physicians and care teams.”
“We are negotiating in good faith with Highmark on behalf of our clinicians and patients to ensure that more of the premium dollars Highmark collects are going toward patient care. Equally troubling are Highmark’s arbitrary policy changes that violate their own contracts and compromise patient care,” Jefferson said in an email Wednesday.
Dan Tropeano, Highmark’s segment for Southeastern Pennsylvania, described the contract talks with Jefferson as normal and expressed confidence that they will reach a positive resolution for both sides.
“Negotiations in general have been more challenging in this cycle than they have in a long while because of the cost pressure that we’re all experiencing,” Tropeano said in an interview Wednesday.
Tropeano noted that Highmark is talking with Jefferson and other providers about ways to change how care is delivered and paid for that would help offset increases.
Estimates of how many patients would be impacted if Jefferson stops taking Highmark insurance next year were not immediately available. Highmark has significant market share in the area Lehigh Valley Health Network serves. It started competing in Southeastern Pennsylvania at the beginning of 2024.
