HARRISBURG, Pa. (AP) – Gov. Tom Wolf and Attorney General Kathleen Kane hailed a court decision Friday that they had sought in a bid to protect Medicare Advantage enrollees caught in the middle of a feud between two western Pennsylvania health care giants.
The ruling by Commonwealth Court Judge Dan Pellegrini orders the University of Pittsburgh Medical Center’s health system to maintain in-network rates until 2019 for people insured by Medicare Advantage plans sold through insurer Highmark Inc.
In addition, Pellegrini ordered the two companies into arbitration to iron out disagreements over the terms of a state-mediated consent decree the parties signed last year. The companies may not make changes to any plan, contract or business relationship between the two “no matter how small” without first getting approval from the court, Pellegrini wrote.
The move in April by UPMC to cancel its Medicare Advantage contract with rival Highmark had meant about 180,000 seniors in western Pennsylvania could lose in-network access to UPMC hospitals and doctors next year. The Wolf administration and the state attorney general’s office went to court seeking to block the move.
Kane’s office said the decision vindicated its position and gives clarity to seniors. Wolf chastised both Highmark and UPMC, and accused the companies of using the vulnerable health care customers as “pawns” in their long-running dispute.
“The feud between these two companies must end – the people of Western Pennsylvania have had enough,” Wolf said in a statement.
UPMC terminated its Medicare Advantage arrangements with Highmark beginning next year, claiming that Highmark had refused to pay a premium for treating cancer patients. Highmark, it maintained, was contractually obligated to pay the premiums.
In his three-page order, Pellegrini rejected UPMC’s claim that Highmark had violated the consent decree, and he ruled that Medicaid Advantage enrollees are to be included in the definition of “vulnerable populations” that merit projection under the agreement.
UPMC blasted Pellegrini’s decision and promised a swift appeal to the state Supreme Court.
Pellegrini’s order is “arbitrary and capricious” and putting the Highmark-UPMC business relationship under his supervision goes well beyond the authority of the court, UPMC said in a statement. A Highmark spokesman lauded the decision and said the company plans to offer a variety of Medicare Advantage product options.
The companies entered the state-mediated consent decree to protect customers after UPMC refused to extend its in-network provider agreement with Highmark, starting this year. Precipitating the fight was Highmark’s acquisition of seven western Pennsylvania hospitals. UPMC claimed that that made the insurer a rival provider to UPMC, which also offers its own insurance plans.
Pellegrini’s decision comes ahead of a Monday deadline for Highmark to submit its proposed Medicare Advantage plans and premiums to the U.S. Centers for Medicare and Medicaid Services.
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