Axed contracts push doctors from network, UPMC says |
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Seniors trying to pick their Medicare plans for next year are caught in the middle of the latest spat between UPMC and Highmark Inc. over a consent agreement in a longstanding feud between the companies.

At issue is whether seniors who enroll in Highmark’s Security Blue and Freedom Blue Medicare plans can be treated at in-network rates next year by 689 UPMC doctors whose contracts the insurer canceled last week.

UPMC announced Monday that those doctors will be out-of-network because they don’t have a contract with Highmark. It accused Highmark of violating the consent agreement the health giants negotiated this summer with Gov. Tom Corbett and Attorney General Kathleen Kane.

Highmark responded that it offered UPMC’s doctors new Medicare contracts, which UPMC has refused to sign. Until then, Highmark maintains, the Medicare customers should have in-network access to UPMC under protections in the consent agreement.

State officials said they are monitoring the situation but haven’t taken action to resolve the dispute.

“This adds to the ongoing confusion, as senior citizens had been told that Medicare patients would have in-network access (to UPMC), and they’re now in a position where they may have chosen plans and the network changed,” said Jack Krah, executive director of the Allegheny County Medical Society, which represents about 3,000 doctors. “It’s probably going to end up in court again.”

In October, Highmark won a lawsuit brought by Kane and the Corbett administration that sought to hold the insurer in contempt of the consent decree for offering a low-cost Medicare Advantage plan that excluded UPMC doctors and hospitals. Commonwealth Court in Harrisburg sided with Highmark because the insurer’s more-expensive Medicare plans offered in-network UPMC access.

“We cannot speculate on future actions, but we continue to monitor all activity between the two entities,” Kane spokesman J.J. Abbott said.

The consent agreement governs the limited access that Highmark members will have to UPMC facilities and physicians on Jan. 1, when commercial contracts between the two expire. Highmark members outside the Pittsburgh area can access UPMC’s rural hospitals. UPMC’s specialty hospitals, such as Children’s and Western Psychiatric Institute and Clinic, are in-network. Emergency services and oncology are in-network.

Department of Insurance spokeswoman Rosanne Placey said the agency has “heightened our regulatory responsibilities and oversight of the companies on all issues impacting health consumers.”

The dispute could harm the 689 UPMC physicians who may lose patients who are afraid they’ll have to pay out-of-network charges, Krah said.

Highmark is the biggest Medicare Advantage carrier in Western Pennsylvania, with about 145,000 Security Blue and Freedom Blue members in the region. Medicare’s open enrollment period runs through Dec. 7.

The insurer said last week that it terminated the UPMC physician contracts, which covered Highmark’s individual, employer-group and Medicare subscribers, because it needed to update its network directories to reflect that the doctors would be out-of-network on Jan. 1 for individual and employer-group members.

Highmark spokesman Aaron Billger said the company didn’t violate the decree, which applies to Medicare Advantage members.

UPMC spokesman Paul Wood said the network won’t agree to the contracts because it would “set a precedent to allow Highmark to willfully violate” other contracts. UPMC maintained that Highmark was wrong to cancel doctors’ contracts, then argue that subscribers can see them at in-network rates.

“UPMC will not aid and abet Highmark’s illegal and unethical behavior by signing the new contracts,” he said.

Alex Nixon is a staff writer for Trib Total Media.

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