Highmark and UPMC executed a consent decree to govern their post-contract relationship. However, the two organizations have failed to agree on what claims satisfy the language in the decree that qualifies Highmark members to receive in-network rates at UPMC facilities, according to the report.
Highmark supports a narrow interpretation of the language in the consent decree, which would limit its members from getting care at UPMC, while the health system has argued for a broad reading of the language, according to the report.
Lynn Seay, a Highmark spokeswoman, told TribLive the insurer is seeking more detailed information from state regulators about when Highmark members can receive in-network rates at UPMC.
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