Court allows early end to UPMC coverage for Highmark

UPMC will end its in-network coverage of Highmark Medicare Advantage members on June 30, 2019, according to a recent Pennsylvania Supreme Court ruling that reverses a lower court’s order granting coverage through 2019.

Pennsylvania consumers have been caught in the middle of a spat between the state’s largest health system and insurer involving the expiration of consent decrees signed five years ago.

The breakup began in 2012, when UPMC and Highmark agreed to end Highmark members’ in-network access to UPMC facilities by the end of 2014. The organizations in mid-2014 signed consent decrees extending access through June 2019.

Early this year, Highmark and state officials lobbied the Commonwealth Court, arguing that Highmark MA members should be covered through 2019 because Medicare contracts span the calendar year.

But the Supreme Court ruled that a six-month run-out provision in the consent decrees “satisfies UPMC’s obligation to contract for in-network access to its facilities for Highmark’s MA subscribers through June 30, 2019.”

UPMC lauded the ruling in a statement while Highmark said it was disappointed.

Highmark and UPMC are pitted in an arms race as they look to maintain a competitive edge in the rapidly consolidating Pennsylvania market.

Highmark’s Allegheny Health Network hospital chain has been preparing for its upcoming divorce from UPMC through partnerships with Penn State Health in Hershey and Danville-based Geisinger Health. UPMC formed a joint venture with Reading Health System in 2016 and merged with Harrisburgbased PinnacleHealth in 2017.