State officials prompt UPMC, Highmark to go to mediation to resolve Medicare dispute |
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State officials prompt UPMC, Highmark to go to mediation to resolve Medicare dispute

State officials called a truce on Wednesday in an ongoing feud between Highmark Inc. and UPMC over Medicare customers, telling the warring health giants “your actions in the past two weeks have created additional uncertainty and confusion for the senior population.”

To reduce the confusion among Highmark’s Medicare Advantage members, UPMC and Highmark agreed to resolve their dispute as called for by a consent agreement they signed this summer. The agreement calls for 30 days of state-facilitated mediation. If that fails, UPMC and Highmark must enter binding arbitration.

While the two sides work through their issues, Highmark agreed to rescind contract terminations issued to 689 UPMC physicians, which touched off the dispute last week. UPMC said it would stop telling seniors they will lose access to its system of doctors and hospitals starting on Jan. 1.

Terms of the truce were laid out in a letter to the CEOs of both organizations from Attorney General Kathleen Kane, Insurance Commissioner Michael Consedine and Health Secretary Michael Wolf.

“The Commonwealth is seeking to provide seniors with certainty during this transition, and today’s agreement by both parties to provide clarity rather than confusion is a first step in the right direction,” according to the letter, which was released to the media.

The fight started when Highmark terminated contracts for the UPMC physicians, saying that those doctors would always be out-of-network for Highmark’s individual and employer-group members under terms of the consent agreement that give Highmark members limited access to UPMC starting next year.

But the canceled contracts also covered Highmark Medicare Advantage members.

Highmark said it offered new Medicare-only contracts to the doctors, but UPMC refused to sign. UPMC argued that Highmark’s termination of the contracts was a violation of the consent agreement.

A federal review of Highmark’s Medicare Advantage network, prompted by the contract terminations, is ongoing. Officials with the Centers for Medicare & Medicaid Services could not be reached for comment.

Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or [email protected].

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