UPMC, Highmark battle rages on

Health insurer Highmark is preparing to arbitrate its ongoing cancer care dispute with Pittsburgh-based UPMC, according to a Pittsburgh Business Times report.

Medicare regulations allow health systems to bill insurers at hospital outpatient center rates for the same care provided in system-owned physicians' offices, a practice that sometimes leads to reimbursement being tripled. Highmark quit paying UPMC the higher rates for cancer care in April 2014, according to the report.

Last week, UPMC warned that those with Highmark Medicare Advantage plans will be pushed out of the system's network Jan. 1, 2016, unless Highmark increases the rates it pays to UPMC for cancer care. UPMC is also demanding that Highmark drop a lawsuit against the system alleging it had overpaid UPMC on chemotherapy fees since 2010.

Highmark spokesman Aaron Billger told the Pittsburgh Business Times the cancer care dispute will be submitted to a three-person arbitration panel by late summer.

However, UPMC spokesman Paul Wood told the Pittsburgh Business Times he doesn't know of any arbitration plans and isn't sure what arbitration the health insurer could be talking about.

Regardless of the way the disagreement is settled, both Highmark and UPMC could be negatively affected by the dispute. Highmark could lose Medicare Advantage members who choose to switch to another insurer to keep their UPMC physicians, while UPMC could lose a portion of its Medicare Advantage patients, according to the report.

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