Pa. Supreme Court Issues Decision in Highmark-UPMC Medicare Advantage Case

Last Updated: Jul 26, 2018

health-insuranceOn July 18, 2018, the Pennsylvania Supreme Court issued a unanimous decision in a case involving the insurers UPMC and Highmark.

The court ruled that in-network access to UPMC hospitals will end on June 30, 2019 for subscribers to Highmark’s Medicare Advantage plans Security Blue HMO and Freedom Blue PPO. The Pa. Supreme Court’s decision reverses a lower court ruling that had extended that UPMC in-network hospital access through 2019, reports the Pittsburgh Post-Gazette.

In a media statement, Highmark noted that its Security Blue HMO and Freedom Blue PPO members will continue to have in-network access to all UPMC hospitals including those in Pittsburgh and Erie through Dec. 31, 2018.

Highmark also said that there is no change for Highmark's Community Blue Medicare HMO and PPO or Medigap Blue members as a result this ruling. Since Medigap supplemental insurance has no network, all Medicare Part B participating providers must bill and accept Medigap insurance products.

UPMC confirms that 2018 is the last calendar year that UPMC is a part of Highmark’s Security Blue or Freedom Blue networks in the Greater Pittsburgh and Erie areas. “Seniors who choose those Highmark products for 2019 will have in-network access to UPMC in those areas through June 30, 2019 only,” UPMC said in a news release.

You can find statements issued by both insurers following the Pa. Supreme Court’s decision here:

Physicians and practices with specific questions concerning the affected plans should contact UPMC or Highmark directly.

1 comment

Leave a comment
  1. Anand Nilay Popuri | Jul 26, 2018
    Does anyone else think this is criminal?  Insurance companies are creating monopolies over hospital systems.  Patients are no longer able to the hospital of their choice.  This is seen as a huge strain on the health system in Erie PA where traditional the hospitals worked together to provide the necessary services for the community.  I think anyone supporting this huge division, is only doing it for money.  This is certainly not in the best interest of patients.

    Leave a comment

    Return to the art of medicine - MACRA

    norcal advertisement
    Norcal Mutual

    Learn More 
    norcal advertisement