Attorney general sues over patient access to UPMC's network
Pennsylvania Attorney General Josh Shapiro sued Thursday to keep health giant UPMC from ending its business relationship with rival Highmark Health.
He asked Commonwealth Court to forestall developments expected July 1 that would leave some Highmark insurance customers facing higher fees or looking for new doctors.
The 73-page petition to modify consent decrees seeks to enforce Pennsylvania laws about fundraising for charity, nonprofit corporations and consumer protections. It aims to modify and indefinitely extend 5-year-old consent agreements that have kept some Highmark Medicare Advantage members and others with in-network rates for UPMC services.
The attorney general’s office wants the court to impose a single, modified consent decree that would continue the business relationship between UPMC and Highmark, both based in Pittsburgh, two of Pennsylvania’s largest charitable institutions. Highmark has agreed to Shapiro’s proposed deal but UPMC has not.
Highmark Health chief executive David Holmberg said a modified agreement would be in the community’s best interest.
A UPMC spokesman said there is no state law that gives the attorney general the authority to force private parties into contracts. The region’s insurance marketplace has been changing in recent years, and consumers have benefited, said UPMC vice president Paul Wood.
Highmark officials said that if the agreements expire as scheduled on July 1, nearly 70,000 customers in the Pittsburgh area and Erie will find themselves out of network, hit with higher costs for UPMC services, or needing to find new doctors. Shapiro wants the court to “enable open and affordable” access to UPMC services through contracts with any health plans, to require arbitration when talks between insurers and providers fail, and to prohibit “excessive and unreasonable” billing.
The business relationship between UPMC and Highmark was about to end when former Gov. Tom Corbett’s administration in 2014 engineered five-year consent decrees between the companies that kept in-network rates for Highmark customers in the Pittsburgh area and Erie.
UPMC had been opposed to renewing their agreement in 2012 after Highmark purchased what is now Allegheny Health Network and became a UPMC competitor in providing health services as well as in insurance coverage.
