UPMC-Highmark feud metastasizes in Westmoreland cancer center billing dispute
The feud between Highmark and UPMC has spilled over to Westmoreland County's Arnold Palmer Cancer Pavilion — a joint UPMC-Excela Health venture — where officials say Highmark is refusing to pay reimbursements for chemotherapy treatments.
But Highmark officials say they are not issuing reimbursements because the cancer center is billing the insurer as if the treatments were administered at a hospital nearly 25 miles away.
Excela Chief Executive Officer Robert Rogalski said the insurance giant hasn't paid the health system since March, forcing it to redirect money from other operations to the center.
None of the parties involved will divulge the exact amount of money in question.
“Highmark has paid zero dollars since March,” Rogalski said. “It's a significant amount of money. It's millions of dollars. It's draining our cash from the operation … . ”
But Highmark spokesman Michael Weinstein said the reason the company has refused to pay is because the cancer center is billing the insurer as if its patients receiving infusion chemotherapy by port, needle or catheter at UPMC-McKeesport.
Weinstein said cancer treatments performed at a hospital garner higher reimbursements than those done at outpatient facilities such as the Arnold Palmer Pavilion.
“Why is that important? It's important because the amount of money Highmark, and I assume other insurance companies, would pay for services, would be triple the amount we now pay,” he said.
Weinstein said that if Highmark permitted all of its customers to bill in this manner, it could increase costs to employers and patients by an additional $25 million annually.
“Highmark is ready and willing to pay these bills if UPMC submits them the way the center has historically billed us for those service,” Weinstein said.
UPMC officials also lashed out at Highmark.
“Highmark, once again, is showing little regard for quality by denying the claims of these patients,” said UPMC spokeswoman Jennifer C. Yates.
“Other insurers are recognizing this facility as a hospital-based clinic and this is just another way that Highmark is hurting community hospitals,” she said.
“Most of our oncology services are provided through hospital-based practices — as they are at most major medical centers across the country,” Yates added. “The Arnold Palmer Cancer Center provides the highest in patient care and meets the highest standards in quality because of its conversion to a hospital-based clinic.”
UPMC provides staff at the Arnold Palmer Pavilion and Excela owns the property, Rogalski said. About 130 patients a day are treated at the facility where UPMC and Excela equally share costs and revenue.
Rogalski said Highmark is paying reimbursements for all other services provided at the center, including radiation treatments.
UPMC last year notified Highmark it was shifting billing for chemotherapy to UPMC-McKeesport, he said.
Rogalski said UPMC changed the way it submits bills to Highmark because the treatment patients receive at Palmer is the same as at a hospital.
“The change is not unusual,” he said. “Every other cancer center in the region is paid this way.”
Weinstein disputes that.
“Nobody was given notice of change in the way chemotherapy infusion services was billed. Highmark learned of it when it began to receive claims,” he said. “We started to see the same services are being billed differently because it adds much more to costs.
“We recognize the financial concerns all hospitals are facing and are looking for ways to increase revenue,” Weinstein said.
Rogalski said he is negotiating with Highmark to resolve the reimbursement issue in hopes of avoiding a legal entanglement.
He added that he does not expect any cutbacks at the center as a result of the reimbursement battle.
Richard Gazarik is a staff writer for Trib Total Media. He can be reached at 724-830-6292 or at firstname.lastname@example.org.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Family of man accused of shooting St. Clair officer say allegations don’t fit his character
- 40 years later, siblings of South Greensburg girl who disappeared still seek closure
- French and Indian War re-enactor Wilson commits to pioneer lifestyle in Murrysville cabin
- Drones hover at top of holiday wish lists
- Excela, Pitt-Greensburg team on legacy videos for those in twilight of lives
- Family collecting donations for Salem man seriously injured in deer stand fall
- School lunch group hopes to revise rules it calls impractical, too restrictive
- $2,000 donated for abused puppies recovering at South Huntingdon shelter
- Western Pa. students bristle at changing menu choices
- Jeannette trudges through blight
- Contractor eyes early finish to work on New Stanton interchange of Interstate 70