Highmark Medicare Advantage Members Lose UPMC In-Network Services July 2019

How will vulnerable patients be affected by the PA Supreme Court decision?

Jennifer Bloodworth
July 19, 2018 - 5:01 pm
Highmark Building in Downtown Pittsburgh

PITTSBURGH (NewsRadio 1020 KDKA) — Highmark Medicare Advantage members will no longer have in-network access to UPMC through the end of next year.

The state Supreme Court overturned a decision Wednesday that expanded the agreement between the healthcare giants from a July 2019 end date through all of 2019.

The initial ruling in Commonwealth Court hinged on the fact that Medicare contracts run on a calendar year, but the Supreme Court found a six-month run out provision in the consent decrees signed by both organizations five years ago allows UPMC to terminate coverage at the end of June 2019.

Duquesne University health care historian Dr. Andrew Simpson told the KDKA Radio Afternoon News the termination of services could cause more issues for Medicare Advantage members than other, younger populations.

“In an older population … you’ve got a population that may have long-standing relationships with particular physicians that now may not be able to access to them,” Simpson said. “It also raises questions about older patients who might have cognitive issues who can’t meet with a doctor and talk about care plans.” 

Simpson says transfers of medical records between health care systems are also a concern, as many elderly patients have specialized medication needs.

Simpson says Pittsburgh’s heath care feud is unique, but that may change as payers and providers continue to merge.

He adds that just because this particular issue is limited to Medicare Advantage plans doesn’t mean it’s not a major roadblock for many Americans with an estimated 10,000 Boomers turning 65 every day across the country.

“I think this is going to continue to be a major issue,” Simpson said. “As the Baby Boomers age and we deal with issues in our region that has an older population … this is going to continue to be something that both Highmark and UPMC and their customers are going to have to confront.”  

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