PITTSBURGH (KDKA) — The ongoing dispute between Highmark and UPMC is heating up again.
“Classic bait and switch,” says UPMC spokesperson Paul Wood.
This time the issue involves Magee Women’s Hospital, a UPMC facility where at least 10,000 babies are born each year.
Beginning this year, the hospital is off-limits at lower insurance rates to many Highmark-insured women, including almost all who get pregnant in 2015.
But that leaves some others.
This dispute involves 500 to 700 Highmark-insured women who got pregnant in 2014 and with their independent doctors want to give birth at Magee at lower in-network rates.
Highmark says they can’t do that. UPMC says of course they can.
“Under the terms of the consent decree that both UPMC and Highmark signed back in June, that woman is absolutely allowed to deliver her baby at in-network rates at UPMC, and specifically, at Magee Womens Hospital,” says Wood.
Wood says Highmark is mistreating their insured women because they’re desperate for patients at the Allegheny Health Network facilities.
“It’s extremely slow there. They are simply not seeing women choosing to go there to deliver their babies.”
Highmark denies that.
And while not available on camera, Highmark said in a written statement that they’ve warned independent doctors for 15 months that Magee would be off-limits on Jan. 1, adding, “The current situation is a direct consequence of UPMC’s decision not to renew its contract with Highmark, which would have preserved service and access for the entire community.”
The current situation is a direct consequence of UPMC’s decision not to renew its contract with Highmark, which would have preserved service and access for the entire community.
But UPMC insists the consent decree requires Highmark to honor continuity of care and will ask state regulators to get involved.
“We’re going to advocate for these women who have been promised by their independent OB/GYNs the ability to deliver at Magee,” said Wood.