Highmark Patients In-Network for UPMC, Court Rules

Under a consent decree with the state of Pennsylvania, UPMC must treat Medicare Advantage patients covered by Highmark Health as in-network patients until at least 2019, according to a ruling by that state’s supreme court Nov. 30 (Commonwealth v. UPMC, 2015 BL 391965, Pa., 48 MAP 2015, 11/30/15).

In a 3-2 split decision, Justice Debra McCloskey Todd found that a clause of the consent decree that required uninterrupted in-network coverage for “vulnerable populations” included patients who are covered by Highmark’s Medicare Advantage programs that were in existence when the decree was signed in 2014. Justice J. Michael ...