The arbitration panel determined Highmark improperly reduced oncology payments to UPMC Shadyside Hospital for patients with Highmark’s commercial plans from April 2014, through October 2015. The panel determined Highmark owed UPMC Shadyside $24 million.
Although the panel’s decision solely focused on payments to UPMC Shadyside, UPMC said Highmark has agreed to pay a total of approximately $188 million to resolve claims across the hospital system, according to the report.
The bill for the difference between what Highmark paid and what UPMC charged might be passed along to employers and self-insured customers who buy insurance in the commercial market.
“These were not funds that Highmark paid, but rather that employers and self-insured customers paid,” a Highmark spokesman told TribLive. “In the event that UPMC has had a material financial change, those funds would be coming from the employers and residents of Western Pennsylvania.”
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