UPMC spikes controversial 'prepay' policy for Highmark MA members

Pittsburgh
The University of Pittsburgh Medical Center said it wants to take steps to avoid surprise bills for Highmark Health members after the consent decree ends. (Getty/Joecho-16)

The University of Pittsburgh Medical Center (UPMC) announced Wednesday that it has rethought a controversial “prepay” plan for Highmark Health plan members ahead of the companies’ looming breakup. 

UPMC and Highmark’s multiyear consent decree that requires each cover care at the other’s provider facilities in-network will end on June 30, and UPMC said that it would not seek advanced payment from Highmark’s Medicare Advantage members if they seek care at UPMC facilities after the decree ends. 

In addition, it said it will accept direct payment from Highmark for out-of-network emergency care at the rates it charges its own health plan members. 

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“As the consent decrees near end on June 30, our intent is to ensure that Highmark members can receive emergency and other care that they need without being caught in the middle of billing issues with their insurer,” Paul Wood, chief communications officer at UPMC, said in a statement. 

The response to UPMC’s policy faced fast backlash, and earlier this year Sen. Bob Casey, D-Pennsylvania, asked Department of Health and Human Services Secretary Alex Azar to intervene, the Pittsburgh Post-Gazette reported

RELATED: UPMC, Highmark break up making it hard to do enrollment for seniors 

UPMC said in the announcement that the decision was “prompted” by comments from Highmark that indicated it would do the same. If Highmark doesn't follow through, UPMC threatened to reconsider the prepay plan. 

In a statement to FierceHealthcare, Highmark spokesman Aaron Billger said of UPMC's original plan that it’s a “shame they promoted [the policy] in the first place.” 

“We have always been focused on doing what is right for our customers and patients,” Billger said. “We are glad UPMC is in agreement with us. We have long said UPMC’s actions were unnecessary and unprecedented.” 

UPMC and Highmark’s long-standing feud over market share in greater Pittsburgh dates back to 2011 when Highmark bought what is now Allegheny Health Network, challenging UPMC in the provider arena. State officials intervened in 2014, leading to the soon-to-expire agreements. 

UPMC is currently embroiled in a legal battle with Pennsylvania’s attorney general over the end of the consent decree. Attorney General Josh Shapiro filed suit against UPMC in February with the goal of pushing the healthcare giant into a modified version of the consent decree—Highmark backs the new plan. 

Pennsylvania’s Supreme Court recently weighed in on the case, sending it to the lower Commonwealth Court for final judgment. The Commonwealth Court previously determined that the consent decree would end in June as scheduled. 

The Commonwealth Court is expected to take an expedited path to resolution. 

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