How UnitedHealthcare could benefit from the Highmark-UPMC battle

Pennsylvania seniors caught in the middle of the feud between UPMC and Highmark will have another Medicare Advantage option this fall when UnitedHealthcare makes its Medicare Advantage plans widely available in Western Pennsylvania, according to a TribLive report.

Earlier this year, Pittsburgh-based UPMC warned those with Highmark Medicare Advantage plans would be pushed out of the system's network Jan. 1, 2016, unless Highmark increased the rates it pays to UPMC for cancer care. In April, Pennsylvania Gov. Tom Wolf and Pennsylvania Attorney General Kathleen Kane filed a joint motion alleging UPMC's plan to end its Medicare Advantage arrangement with Highmark would violate the decree the two organizations entered into in the summer of 2014. The state's motion was granted, and UPMC appealed the decision.

With the battle between UPMC and Highmark playing out in the Pennsylvania Supreme Court, UnitedHealthcare made a move to allow it to capture some of those caught in the middle of the feud, as it has two HMO-style plans listed on CMS' website to be offered in Western Pennsylvania in 2016. UnitedHealthcare joins Aetna and Humana in competing for a share of the market, which is currently dominated by Highmark and UPMC.

"It's an unfortunate situation with the feuding between UPMC and Highmark," Brian Breisinger, president of Pittsburgh-based national insurance marketing firm Gateway Strategies, told TribLive. "But we also believe that this is creating a pivotal period in the health insurance marketplace in Pennsylvania."

The Pennsylvania Supreme Court will hear arguments Oct. 6 on whether UPMC is required to continue providing healthcare at in-network rates to seniors with Highmark Medicare Advantage plans.

More articles on payer issues:

2 Georgia health systems to discontinue Medicare Advantage plan
Anthem merger filing reveals new details about Cigna deal
Federal, state regulators shut down New York's health insurance co-op

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Top 40 articles from the past 6 months