Pittsburgh-based UPMC and health insurer Highmark declined a judge's invitation on Wednesday to engage in negotiations as an attempt to resolve a conflict over UPMC hospital network access for Highmark Medicare Advantage customers for next year, according to a Pittsburgh Post-Gazette report.
UPMC's Chief Legal Officer W. Thomas McGough refused to engage in negotiations, as he said only the system's board of directors could make that decision. Daniel Booker, an attorney for Highmark, also said no to the opportunity to negotiate. "There is no agreement to be reached here," he said, according to the report.
The disagreement between the parties centers on UPMC's warning earlier this year that those with Highmark Medicare Advantage plans will be pushed out of the system's network Jan. 1, 2016, unless Highmark increased the rates it pays to UPMC for cancer care.
Medicare regulations allow health systems to bill insurers at hospital outpatient center rates for the same care provided in system-owned physicians' offices, a practice that sometimes leads to reimbursement being tripled. Highmark quit paying UPMC the higher rates for cancer care in April 2014.
Last month, Pennsylvania Gov. Tom Wolf and Pennsylvania Attorney General Kathleen Kane filed a joint motion alleging that UPMC's plan to end its Medicare Advantage arrangement with Highmark would violate the decree the UPMC and Highmark entered into in June 2014.
Commonwealth Court President Judge Dan Pellegrini is now tasked with making a ruling regarding the consent decree violation, and there is no timeline as to when that ruling will be made. "You'll get it when you get it," Judge Pellegrini told the parties' lawyers during the Wednesday hearing, according to the report.
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