UPMC to End Medicare Deal with Highmark
The University of Pittsburgh Medical Center is threatening to terminate its Medicare contract with rival Highmark, which could cause about 180,000 seniors in western Pennsylvania to lose in-network access to UPMC hospitals and doctors next year.
UPMC says Highmark has refused to pay contracted rates for cancer treatment at the Hillman Cancer Center in Shadyside.
Spokesman Paul Wood said Highmark owes UPMC about $143 million.
But Gov. Tom Wolf called UPMC's plans "simply unacceptable" and said his administration would consider all options to stop the medical system from ending the contract, including legal action.
In a statement emailed to reporters, the governor cited a state-mediated agreement that governs the break-up between Highmark and UPMC. He called the medical system's decision "a clear violation of UPMC's commitment to protect senior citizens and vulnerable populations as enshrined in the consent decree."
Highmark spokesman David Carter said UPMC is trying to force the insurer to drop litigation related to what he called "outrageous" price increases for oncology drugs.
Attorney General Kathleen Kane called on the parties to "come back to the table and resolve this conflict."
"We have grown weary of the near-constant skirmishes between these parties, who both have been at fault at one time or another," she said in a statement. "The constant upheaval of services has created fear and confusion for consumers that we are in the process of trying to dispel."
Policies of the federally subsidized Medicare health program for those 65 and older are renewed annually and run from Jan. 1 to Dec. 31. About 182,000 western Pennsylvania seniors have a Highmark Medicare Advantage policy.
UPMC is western Pennsylvania's dominant network, with 22 hospitals and 400 outpatient sites. But the hospital has complained that Highmark is now a competitor because the insurer recently acquired seven area hospitals from Erie to Pittsburgh.