Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Medicare Payment Dispute Heats Up Highmark May Be Considering Methods to Counter Upmc

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Medicare Payment Dispute Heats Up Highmark May Be Considering Methods to Counter Upmc

Article excerpt

The latest battlefront in the seven-year war between Highmark and UPMC gained extra fuel Thursday, less than a year from what's supposed to be a final dissolution to the Pittsburgh health giants' decades-long relationship.

At a public forum Downtown on coming changes in Medicare, a Highmark official hinted the insurer is looking at strategies to respond to UPMC's plans to require Highmark Medicare Advantage members to pay upfront and in full for receiving UPMC services once consent decrees expire June 30.

"As long as there's disruption in the marketplace, Highmark will find ways to overcome it," said Ellen Galardi, Highmark's vice president for Medicare products.

"We are here to pay claims. That's what we do," she said at another point.

Afterward, Ms. Galardi declined to provide details on the insurer's plans, but she did not dispute that Highmark is working on some, saying officials there "don't want to put members in the middle" of the disagreement with UPMC.

Her remarks came at a gathering of more than 100 people organized by the Allegheny County Apprise program, which provides free counseling to seniors regarding their health care options.

While some audience members had general questions about what's in store for 2019 plan offerings, much of the discussion centered on the pending end of Highmark members' in-network access to UPMC hospitals in Pittsburgh and Erie.

Also on Thursday's panel was Mark Tamburri, UPMC senior associate counsel, who reiterated the Pittsburgh health system's position that after June 30 members with out-of-network plans - including Highmark's Freedom Blue and Security Blue plans - will be expected to pay upfront the cost set by the Centers for Medicare and Medicaid Services' fee schedule.

"There's no contract so we have no guarantee that we will get paid and we don't know if we'll ever get paid," he said.

The latest dust-up started Oct. 1, the first day that insurers were allowed to make public their Medicare Advantage plans for 2019.

First, Highmark announced that Freedom Blue and Security Blue Medicare Advantage members would have access to an out-of-network benefit enhancement next year in which they would be reimbursed for out-of-network care at UPMC. …

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