Highmark Medicare Advantage members to go out of network with UPMC in June 2019

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Thousands of Highmark Medicare Advantage members will lose in-network access to Pittsburgh-based UPMC a year earlier than expected, according to a state Supreme Court decision cited by Trib Live.

A state-brokered consent decree between Highmark and UPMC expires in June 2019, after which Highmark's Medicare Advantage members will not be able to access UPMC at in-network rates. While a Commonwealth Court judge initially interpreted the consent decree to mean UPMC must accept Highmark insurance through June 2020, Pennsylvania's Supreme Court disagreed.

"We are disappointed in today's Pennsylvania Supreme Court ruling," Highmark said in a July 18 statement. "While this is not how we interpreted the Consent Decrees intended to guide the Highmark and UPMC relationship, we will work in full compliance with the ruling and trust UPMC will do the same."

A UPMC spokesperson commented on the court decision to Trib Live: "UPMC is grateful the Supreme Court expeditiously reached this decision, allowing seniors ample time to make the best choices for their healthcare."

Pennsylvania brokered the consent decree in 2014 amid souring relations between Highmark and UPMC. At the time, Highmark said it was buying the former West Penn Allegheny Health System in Pittsburgh. UPMC responded by saying it could not contract with a health insurer that owns a competitor.

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