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Judge rules UPMC must accept Highmark Medicare Advantage members

Pittsburgh Post-Gazette (PA) - 5/29/2015

May 29--HARRISBURG -- UPMC must continue to see Highmark's Medicare Advantage members on an in-network basis as the two sides negotiate terms on disputed payments, a judge ruled today.

Commonwealth Court President Judge Dan Pellegrini also ordered that the two Western Pennsylvania health care giants make no change to their business relations, "no matter how small," without court approval.

Judge Pellegrini set a schedule for arbitration.

Attorneys for the state, UPMC and Highmark argued the question of UPMC access for Highmark Medicare Advantage customers during a 10-hour hearing Wednesday.

By Monday, Highmark must submit its proposed Medicare Advantage plans and premium schedules to the U.S. Centers for Medicare and Medicaid Services, which vets privately administered plans.

The Medicare open-enrollment period, when beneficiaries can switch plans, begins Oct. 15.

Highmark has about 182,000 Medicare Advantage customers in Western Pennsylvania.

UPMC severed its Medicare Advantage contract with Highmark, citing a dispute over oncology payments.

Spokesman Aaron Billger said Highmark was pleased the court agreed with state regulators "that UPMC cannot walk away from 182,000 seniors in our community."

"We look forward to offering our Medicare Advantage members a variety of product options at a variety of price points to meet their health care needs," he said.

UPMC spokesman Paul Wood called the ruling "arbitrary and capricious," and said the hospital system will immediately appeal to the state Supreme Court.

He also noted the requirement that UPMC and Highmark receive approval for any changes in contract.

"This was not requested by the Commonwealth, nor does the Court and, in particular, this judge, have any such authority to assume control of health care in Western Pennsylvania," Mr. Wood said.

Karen Langley: klangley@post-gazette.com or 717-787-2141 or on Twitter @karen_langley.

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