Supreme Court Hears UPMC's Appeal Of Medicare Ruling

PITTSBURGH (KDKA/AP) - The Pennsylvania Supreme Court heard arguments in the University of Pittsburgh Medical Center's appeal of a lower-court ruling forcing it to maintain in-network rates for Highmark Inc.'s 182,000 Medicare Advantage customers.

Commonwealth Court Judge Dan Pellegrini orders in May ordered UPMC to maintain the cheaper rates through 2019 for Medicare Advantage subscribers who use UPMC's doctors and hospitals.

UPMC argues they are under no legal obligation to include Medicare Advantage members in their network beyond the end of this year.

The attorney who represented the State Attorney General and the Insurance Commissioner argued that UPMC is backing out of a commitment to maintain those customers until 2019.

And Highmark argued that the consent decree language is clear UPMC is to maintain the coverage.

BUT UPMC's lawyer says if the court agrees with them, Highmark Medicare Advantage seniors still have options.

"We had the absolute right to non-renew or terminate and the population of western Pennsylvania has every right in the world, and should exercise their rights to go out and get competition at competitive rates," said attorney Steve Cozen. "43,000 people left Highmark last year. Where did they go? They went to Aetna, they went to United, they went to a lot of other carriers and they can get UPMC services from docs and hospitals or they can choose to go somewhere else. It's part of the marketplace," Cozen said.

But given the size of this case record it could be months before the Pennsylvania Supreme Court decides who's right.

The Wolf administration and the state attorney general's office went to court seeking to block the move, prompting Pellegrini's decision.

A decision is not expected before Medicare's open enrollment period begins in nine days.

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