The Pennsylvania Department of Health has sent a letter to the CEOs of Pittsburgh-based UPMC and health insurer Highmark Health requiring the two parties to resolve continuity of care issues for Highmark customers, according to a Pittsburgh Post-Gazette report.
In a consent decree executed in summer 2014, UPMC and Highmark agreed that "the continuation of care of a Highmark member in the midst of a course of treatment at UPMC shall be on an in-network basis, at in-network rates," according to the report.
The letter from the Department of Health addresses the disagreement between UPMC and Highmark over what qualifies as continuity of care under the consent decree.
According to the Post-Gazette, some UPMC physicians have been telling their Highmark customers they may have clinical access at UPMC through mid-2019. However, the Department of Health letter says, "Unless Highmark and UPMC come to a different agreement, patients who have simply seen physicians for basic preventive care, non-serious, or non-recurrent illnesses, injuries, etc., would not be eligible for continuity of care under" the consent decree.
UPMC said all of the conditions listed in the letter could qualify as continuity of care. Unlike UPMC, Highmark agrees with the Department of Health and believes the terms in the letters are "consistent with the intent of the consent decree," according to the report.
More articles on Highmark:
Judge blocks Highmark from terminating contract with Aetna
Highmark, Allegheny Health Network, Johns Hopkins sign master collaboration agreement
Aetna sues Highmark over Jefferson Hospital contract