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Highmark Medicare Advantage members get longer access to UPMC, judge rules

Ben Schmitt
| Monday, Jan. 29, 2018, 4:45 p.m.

A portion of the divorce between Highmark Health and UPMC will be delayed for six months, a Commonwealth Court judge ruled Monday.

Senior Judge Dan Pellegrini ruled that Highmark Medicare Advantage members will have in-network access to UPMC doctors and facilities for all of 2019.

UPMC contended access should conclude after June 30, 2019, when a consent decree between both health systems expires.

“We have long said this decision was the intention of the Highmark and UPMC consent decrees,” Highmark spokesman Aaron Billger said. “Today's ruling brings much needed clarity to the community. We will work in full compliance with the ruling and trust UPMC will do the same. We have a singular focus and that's doing what is right for our members.”

The state brokered a consent decree governing relations between the health care companies in 2014 after the companies couldn't resolve contract disputes. The terms of the 2014 agreement expire at the end of June 2019.

UPMC said it plans to appeal Pellegrini's decision.

“This decision is incorrect, we disagree with it and will appeal to the Pennsylvania Supreme Court,” UPMC spokesman Paul Wood said. “We expect to have clarity on this prior to the start of October's Medicare Advantage open enrollment period.”

The state, through Attorney General Josh Shapiro, argued on behalf of Highmark's assertion that the Highmark Medicare Advantage members should be given access until the end of 2019.

“I agree with the Commonwealth's suggested resolution,” Pellegrini wrote in his ruling. “It provides certainty to Highmark MA Plan subscribed as well as to Highmark and UPMC regarding their obligations for calendar year 2019...”

Pennsylvania Attorney General Josh Shapiro praised the ruling.

“This court ruling helps protect Western Pennsylvanians' health care coverage and simplifies patients' lives,” Shapiro said in a statement. “The decision today will save consumers money, provide them stability to keep seeing their regular physicians at the same in-network rates through the end of 2019, and give them time to explore future coverage options.”

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991, bschmitt@tribweb.com or via Twitter at @Bencschmitt.

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