UPMC Dropping Prepayments Policy For Some Patients

Jun 6, 2019

University Pittsburgh Medical Center is dropping plans to seek prepayment from out-of-network Highmark Medicare Advantage patients when consent decrees linking the competing health care giants end on June 30. 

In a news released posted on its website Wednesday, UPMC said it would accept direct payment from Highmark at the same rate that UPMC Health Plan now pays Highmark's Allegheny Health Network hospitals. UPMC also will adopt the same contract rate when billing Highmark directly for out-of-network emergency care.

"Our intent is to ensure that Highmark members can receive emergency and other care that they need without being caught in the middle of billing issues created by their insurer," UPMC chief communications officer Paul Wood said in a statement.

UPMC said the decision followed recent statements from Highmark indicating that it will pay UPMC directly and in full for many of these services and "that it, like UPMC, wants to eliminate the need for "balance billing."

Highmark said it never intended to stop.

"We have always been focused on doing what's right for our customers and patients. We are glad UPMC is now in agreement with us. We have long said that UPMC's actions were unnecessary and unprecedented," said Highmark spokesman Aaron Billger.

Wood said UPMC would have to reconsider its decisions regarding prepayment and balance billing if Highmark fails to pay the billed amounts directly to UPMC.

UPMC also announced Thursday that its Hillman Cancer Center will remain at in-network costs to all insurers, including Highmark commercial and Medicare Advantage, after the June 30 deadline.

A Pennsylvania judge plans to rule as early as next week about whether and how the five-year consent decree that's about to expire between the mammoth health care providers and the attorney general's office can be modified.