Ritter Insurance Marketing, Craig Ritter

Highmark Scores Access Victory, UPMC Will Appeal Court’s Decision

The latest in the UPMC/Highmark divorce saga is news that Highmark Medicare Advantage members will retain in-network access to UPMC providers for all of 2019 – a “victory” for Highmark.

The state-brokered consent decree between the two health systems expires on June 30, 2019. UPMC argues that access to their health providers at in-network costs should end at that point. UPMC said they will appeal Commonwealth Court Senior Judge Dan Pellegrini’s decision to the state Supreme Court.

The development is just the latest in a series of legal battles between the two dominating health systems that began earnestly in 2011. At that time UPMC, Western Pennsylvania’s dominant health care provider, announced it would not renew its contract with Highmark, the region’s largest health insurer. Highmark’s plans to build a competing health system likely drove UPMC’s decision.

Following a state-negotiated consent decree to continue to allow in-network access at UPMC facilities, the latest legal battle is yet another case of different interpretations of the same agreement.

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