Pittsburgh-based UPMC must continue to provide in-network services to members of Highmark's Medicare Advantage plans, the Pennsylvania Supreme Court has ruled.
The ruling affirms a state judge's decision in May that said the health system must remain an in-network provider for Highmark's Medicare Advantage plans through 2019 under a consent decree reached between the two battling organizations and the state last year. The state took UPMC to court after the system announced plans to end its Advantage contracts with Highmark because the insurer allegedly failed to pay UPMC contracted rates for cancer care.
As part of its case, UPMC alleged that Highmark stopped paying UPMC contracted rates for cancer care and owed the system
$143 million. The consent decree, UPMC argued, allowed it to end its contracts under such circumstances.
The judges, however, cited a clause within that consent agreement that says UPMC must continue to contract with Highmark at in-network rates for Highmark's “vulnerable populations.”
Highmark and UPMC have been feuding since Highmark, the largest health insurer in the region, acquired a rival health system—now Allegheny Health Network—in 2013. A contract between them expired last year, and a transition plan approved by the Pennsylvania Insurance Department outlined which UPMC facilities and services would be in-network and out-of-network after the contract's expiration. That followed a consent decree signed in June outlining similar measures.
