By John Shumway


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PITTSBURGH (KDKA) – As patients hang in limbo wondering what to do next, the UPMC, Highmark Health divorce is heading for the final breakup.

But Pennsylvania Attorney General Josh Shapiro has filed suit against UMPC to prevent the breakup, and now the health giant is firing back.

When it comes to needing health care, we all want to know what we need will be there when and where we need it. But for many patients in Western Pennsylvania, there is a fear of the unknown as the UPMC Highmark relationship winds toward its ending June 30.

Shapiro wants the medical giants to continue their consent decree beyond the deadline. He says Highmark has agreed and he’s suing UPMC to force its compliance.

UPMC in its filing with the court this week says the attorney general is out of bounds and the Supreme Court held, in no uncertain terms, that the Consent Decree’s termination date-including for Medicare Advantage-was “an unambiguous and material term.”

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The UPMC filing goes on to say Shapiro “is trying to take the Consent Decree out of existence and implement-by coercion-an entirely new agreement that would take effect when the current one expires.”

And UPMC goes on to say Shapiro is operating in Highmark’s interest, not the public interest.

“The requested modification would not only permit Highmark to tier providers and steer patients away from UPMC (and into its own health system) by requiring its members to make cost-prohibitive payments in order to access UPMC, but to also exclude UPMC entirely when it suits Highmark’s needs. By arming Highmark with these exclusionary tools, the attorney general would nullify the very interest he is purportedly seeking to promote: affordable, in-network access to UPMC through compelled contracts,” the court filing says.

But the pressure on UPMC is not just coming from the attorney general. The Post-Gazette, in an editorial Wednesday, called on the UPMC Board to have a change of heart. On the paper’s op-ed page, the President of the Hillman Foundation, David Roger, weighed in on how the Hillman’s would react.

During their lifetimes, the Hillman’s donated over $77 million across the UPMC system and provided the $10 million lead gift to build the Hillman Cancer Center.

Rogers says, “They’d be disappointed, very disappointed, to know it might not be accessible to anybody who needed it. This concerns us. Everyone is concerned. If you have the wrong insurance, you can’t go? If you would ask Elsie, she would say people should have access – all people – even if it has to be provided for free.”

While reluctant to get into a point counterpoint with UPMC in the media the attorney general’s office did issue a statement in response to the latest claims by the health care giant:

“UPMC’s filings are its world view, nothing more. The consent decrees were intended to protect the public and speak for themselves. They say nothing about an orderly wind down of the UPMC/Highmark relationship. In fact, aside from UPMC, no one else has an interest in UPMC winding down its relationship with Highmark or any other health plan. Moreover, the only coercion going on here is UPMC’s attempt to coerce Pennsylvania consumers to pay it a lot more money.”

Meanwhile, as the legal battles rage on patients are advised to start looking into the alternatives after June 30 and not to count on a last-minute agreement that would maintain the UPMC Highmark agreement beyond that date.