Senator presses UPMC, Highmark CEOs to answer questions over coverage change

Sen. Bob Casey, D-Pa., called on Pittsburgh-based Highmark and UPMC to address questions pertaining to how they are preparing patients who will be affected by their impending split, according to the Pittsburgh Post-Gazette.

Four things to know:

1. Starting July 1, approximately 175,000 Highmark Medicare Advantage plan members in the greater Pittsburgh and Erie, Pa., areas will lose in-network access to 11 UPMC hospitals and "most UPMC doctors," according to a UPMC spokesperson cited by the Post-Gazette. The Highmark-UPMC consent decree, struck in 2014, expires June 30.

2. On Jan. 11, Mr. Casey sent a letter to Highmark CEO and President David Holmberg and UPMC CEO Jeffrey Romoff stating that seniors and people with disabilities may still have questions about which physicians and medical facilities will be affected by the change.

"While it would have been best to have these issues resolved ahead of the start of the annual enrollment period on Oct. 15, 2018, that did not occur," Mr. Casey wrote in the letter, obtained by the Post-Gazette. "The ensuing weeks have only added to the confusion Western Pennsylvania Medicare beneficiaries have faced."

3. While the open enrollment period for Medicare Advantage ended Dec. 7, affected beneficiaries can still switch plans between now and March 31 during a national special enrollment period. Still, Mr. Casey asked Mr. Holmberg and Mr. Romoff to request another special enrollment period from CMS once negotiations surrounding its final separation conclude. Mr. Casey requested a response from the executives by Jan. 21.

4. In response to the letter, UPMC spokesperson Paul Wood told the publication that "UPMC supports Sen. Casey's advocacy that CMS designate a special enrollment period for Medicare Advantage enrollees following the June 30, 2019, expiration of the consent decrees." Highmark spokesperson Aaron Billger told the Post-Gazette that "UPMC has acted alone in limiting access for Highmark Medicare Advantage members. We have worked diligently to bring clarity to the market where UPMC has caused confusion."

For the full report, click here.

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