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Wolf Administration Intends to Enforce Highmark, UPMC Consent Decrees

Gov. Tom Wolf and his administration want to assure healthcare consumers that they intend to enforce the consent decrees signed by Highmark and UPMC in June 2014.

According to the administration, both of the healthcare providers have made statements that have led to confusion.

Teresa Miller, the Acting Insurance Commissioner, as well as Karen Murphy, the Acting Health Secretary, announced that they will make sure patients with Highmark plans are able to receive care from UPMC providers as outlined  in the decrees.

“The key is that the consent decrees that were signed by both parties contain explicit consumer protections so that someone who has been seeing a physician can continue to see that physician if the doctor and the patient believe that is the right thing to do,” Ron Ruman, Pennsylvania Insurance Department press secretary, said.

The administration highlighted its position on key consumer protection provisions – including the ability for Highmark policy holders to continue their course of treatment with a UPMC provider if necessary on an in-network basis with in-network rates through June 30 2019.

“And are we going to make sure that folks who are in a continuing course of treatment with a specific provider – and they’re Highmark policy holders and their provider’s through UPMC – is that relationship going to be able to continue, and we believe that’s what the consent decree say – that it should – and we’re going to enforce that,” Ruman said.

For cancer patients, the administration wants to ensure Highmark policy holders have in-network access to all UPMC services for oncology and related illnesses or complications resulting from cancer treatments.

The administration also noted its intent to enforce access to UPMC providers on an in-network basis for seniors 65 years or older who are eligible for or are covered by Medicare, Medigap or a Highmark Medicare Advantage plan.

Ruman said they have yet to have to take any formal action in order to enforce the decrees but want consumers to know they are protected.

“As specific concerns are brought forward by consumers, that will help us along with UPMC and Highmark to further define exactly how these consent decrees will be enforced to make sure that these consumer protections are in place,” Ruman said. 

UPDATE: March 6th 7:30am

UPMC issued the following statement in response to our request for comment.

"UPMC is pleased and grateful Gov. Wolf, Insurance Commissioner Miller, Health Secretary Murphy worked diligently to intervene to enforce this most basic tenet of the Consent Decree; that is, if a patient and their physician (whether independent or UPMC employed) want to continue in-network treatment at UPMC, it’s their determination.  The Commonwealth’s statement today provides needed clarity for patients, subscribers, physicians, brokers, and employers on the definition of “Continuity of Care” and ensures those provisions are no longer subject to any restrictive misinterpretations."