PITTSBURGH (KDKA) – Hold on. Here we go again.
“UPMC’s actions are a breach of the consent decree,” says a Highmark official.
“This is all on Highmark,” retorts a UPMC official.
UPMC and Highmark are locked in another battle that could affect the access of 182,000 senior citizens with Highmark’s Medicare Advantage plan to UPMC facilities at low-cost rates.
“Essentially this is a contract dispute,” says UPMC’s Paul Wood.
Wood says effective January 1st UPMC is canceling Highmark’s Medicare Advantage in-network access because Highmark unilaterally breached a contract and owes UPMC $143 million for cancer treatments.
“They just decided that they wanted to withhold 80 percent of our charges because they can,” Wood told KDKA money editor Jon Delano, “and there’s no place in contract law that permits a company just to change the terms of a contract.”
Highmark’s Dan Onorato says Highmark simply rolled reimbursement rates back to what they once were.
“They want to increase oncology for western Pennsylvania to the tune of $150 million just by changing the address where the bill comes from,” said Onorato.
“We think that’s unconscionable and we don’t believe the people of western Pennsylvania — our employers or individuals — should have to pay that kind of increase.”
Whoever is right, the Wolf administration and Attorney General Kane sent a letter to UPMC in late March, threatening legal action against UPMC for violating the consent decree both parties signed last summer.
“UPMC did get a letter from state officials, but first and foremost the letter is factually incorrect. For a legal standpoint, it is so legally flawed, it’s unbelievable,” noted Wood.
UPMC says it will not rescind its actions until Highmark cures its contract breach which Highmark insists never occurred.
“UPMC should not use the seniors as a wedge to try to get an increase in oncology. It’s that simple. This is about the money,” said Onorato.
And about whom – UPMC or Highmark — gets that money.