Arbitration Requested In Highmark-UPMC Conflict
By Christine Kern, contributing writer
Pennsylvania’s governor and attorney general sue Highmark and UPMC to end dispute.
Pennsylvania Gov. Tom Wolf and Attorney General Kathleen Kane have brought suit against Highmark Inc. and UPMC to force them into binding arbitration, accusing both companies of breaking the state-brokered consent decree they agreed to last June, according to The Pittsburgh Post-Gazette. The complicated rivalry between the two healthcare organizations has most recently resulted in UPMC announcing an end to their in-network access for approximately 180,000 of Highmark's Medicare Advantage patients beginning in 2016.
A former contract that had provided Highmark enrollees with in-network access to UPMC providers ended on Dec. 31, leaving only the consent decree to ease remaining coordination for continued UPMC access for specific medical treatments, according to the Miami Herald. UPMC has indicated that Highmark is behind on payments to UPMC for patient cancer care, while Highmark asserts that it was over-charged by UPMC. The dispute has left the care of numerous patients – many of them senior citizens – up in the air.
“I will not allow our most vulnerable citizens, especially seniors, to be used as pawns in the dispute between UPMC and Highmark,” Wolf wrote in a statement. “UPMC's decision to cancel Medicare Advantage for over 180,000 seniors was the final straw. After reviewing all options with the Office of Attorney General, the Commonwealth has decided to pursue this matter in court to protect seniors.”
Highmark told the media it would welcome enforcement of the decree, while UPMC is questioning the state's request for arbitration. “Consumers, including seniors and people with cancer, have had enough, and the games between UPMC and Highmark must end,” added Wolf.
UPMC is upholding its position, stating that, “While UPMC agrees with the allegation as to Highmark, a careful review clearly demonstrates there’s no substantive or legal basis for any of the Commonwealth’s misinformed claims against UPMC.”
The UPMC statement also asserts, “The termination of UPMC Medicare Advantage agreements with Highmark will not harm seniors. They can expect to enjoy the benefits of more choice and competition and, likely, lower insurance premiums if they choose to stay in a Medicare Advantage plan. Seniors always have the option of opting out of Medicare Advantage and, instead, can enroll in ‘traditional’ Medicare fee-for-service.”
Company spokesman Aaron Billger told the media that Highmark is prepared to “continue to work cooperatively with the commonwealth to protect consumers,” adding “there needs to be certainty in the marketplace, and the confusion must end. But it's disappointing that it takes litigation.”