Pittsburgh-based UPMC and health insurer Highmark Health continue to battle, this time in regard to delivering babies at UPMC Magee, according to a Pittsburgh Post-Gazette report.
The Pittsburgh Post-Gazette reports that Highmark has notified independent obstetricians that they are not allowed to deliver babies of already-pregnant women at UPMC Magee since it is now considered out-of-network.
Highmark spokesman Aaron Billger explained that these Highmark members have a relationship with an obstetrician, but "(have) not developed a course of treatment at Magee," which makes the hospital out of network. However, he did note that there are exceptions if there is an emergency or they are not able to get care at Highmark in-network facilities, the report reads.
UPMC spokesman Paul Wood told the Pittsburgh Post-Gazette that the move is "another Highmark 'bait and switch' that will undoubtedly surprise and anger independent physicians, their patients, the employers in this region that kept Highmark insurance, and the brokers who sold it."
In the report, Michael A. Cassidy, an attorney, who represents one of the independent physician practices, cites a consent decree that both sides agreed to.
That decree states "'that the continuation of care of a Highmark member in the midst of a course of treatment at UPMC shall be on an in-network basis at in-network rates' and that the determination of a need for continuing care 'shall be determined, in the first instance, by the patient’s treating physician' in consultation with the patient," according to the report.
Mr. Cassidy told the Pittsburgh Post-Gazette that the decree language means that UPMC facilities such as Magee are out of network for Highmark members who become pregnant after Jan. 1.
The department of health sent a letter to the CEOs of UPMC and Highmark Health in an attempt to resolve continuity of care issues for Highmark customers. However, the parties failed to reach a resolution by the department's Jan. 9 deadline, according to a Pittsburgh Business Times report.
The dispute centers around the definition of "continuity of care" under the consent decree executed in summer 2014.
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