The long-running feud between insurer Highmark and healthcare giant UPMC continues with news that they've been unable to reach a mediated agreement regarding UPMC doctors treating Highmark's senior members, according to the Pittsburgh Business Times.
That failure to reach agreement means the two may end up in binding arbitration. Highmark and UPMC had agreed in November to settle the dispute through mediation at the urging of state regulators.
But in a letter to UPMC and Highmark leaders, state regulators wrote they were “disappointed that after our numerous efforts to bring the parties together, you are still unable to reach an agreement in the interests of Western Pennsylvania consumers, in particular given the general agreement of the parties on core underlying principles.”
At issue is Highmark's action Nov. 20 terminating contracts with 700 UPMC doctors, many of whom see Highmark members with Medicare Advantage coverage. Highmark offered the doctors new contracts to continue caring for seniors, according to the Times.
The systems have battled over in-network and out-of-network options for Highmark patients and are working through a transition plan approved by the Pennsylvania Insurance Department. The plan outlines which UPMC facilities and services should be available in-network to Highmark patients.
Tension peaked when Highmark agreed to acquire West Penn Allegheny Health System, which had been UPMC's main competitor. Highmark renamed that system Allegheny Health Network.
