State: Highmark should include UPMC in its Medicare Advantage network

The Pennsylvania Attorney General and the departments of health and insurance want Highmark to expand its Medicare Advantage plans to include the University of Pittsburgh Medical Center within its network.

The state said in a request for an injunction, which was filed Friday in Commonwealth Court, that Highmark's new Medicare Advantage Community Blue plans violate a consent agreement with UPMC by excluding the company from its network, announced the insurer. 

After Highmark and UPMC decided to stop working together this summer, they entered a consent decree, which says that Highmark's members can continue using UPMC providers at in-network rates, WTAE reported.

Plus, the state agencies added that Highmark is misleading consumers by not clearly explaining that its Medicare Advantage plans don't include UPMC doctors and hospitals.

In response to the injunction request, Highmark said it gave UPMC the opportunity to participate in its Medicare Advantage networks, but the company refused because the reimbursement levels were too low, the insurer noted.

Highmark added the consent decree was simply a "framework" to help the companies transition consumers away from UPMC. "It was envisioned that there would be latitude--within a specified framework--to develop products and services to meet patient needs," Highmark said in a statement, the Pittsburgh Business Times reported. "Presumably the Commonwealth wanted a competitive marketplace, but with this action it is potentially depriving seniors of a low-cost plan."

Highmark spokesman Aaron Billger added that the state is trying to "dictate product design" with its injunction request.

To learn more:
- read the announcement 
- see the Pittsburgh Business Times article
- check out the WTAE article