The Pennsylvania Supreme Court agreed Tuesday to hear arguments next month in UPMC and Highmark's bitter battle over whether the Pittsburgh-based health system must continue to provide in-network health services to Highmark Medicare Advantage plan members, according to a Pittsburgh Post-Gazette report.
Earlier this year, UPMC warned those with Highmark Medicare Advantage plans would be pushed out of the system's network Jan. 1, 2016, unless Highmark increased the rates it pays to UPMC for cancer care.
UPMC has said it is must halt the in-network access because Highmark refuses to pay what the insurer calls "markups" for certain cancer treatment payments. UPMC reported in June that Highmark owed about $170 million for cancer care, much of which involved Medicare patients, according to the Pittsburgh Post-Gazette.
In April, Pennsylvania Gov. Tom Wolf and Pennsylvania Attorney General Kathleen Kane filed a joint motion alleging UPMC's plan to end its Medicare Advantage arrangement with Highmark would violate the decree that UPMC and Highmark entered into in the summer of 2014.
In June, Commonwealth Court President Judge Dan Pellegrini granted the state's motion, requiring UPMC to provide in-network access to Highmark Medicare Advantage members until 2019, which is the duration of the consent decree UPMC and Highmark entered into last year.
UPMC appealed the decision, and the Pennsylvania Supreme Court agreed to grant UPMC's request for an expedited argument in its appeal.
James Donahue, MD, Pennsylvania's executive deputy attorney general, told the Post-Gazette his office will object to UPMC's plan to push Highmark Medicare Advantage members out of network at the hearing scheduled for Oct. 6.
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