With the contract between Pennsylvania health giants Highmark and the University of Pittsburgh Medical Center ending today, many consumers are uncertain how the separation will impact them, the Pittsburgh Tribune-Review reported.
The battle between Highmark and the University of Pittsburgh Medical Center (UPMC) has led to a more wide-reaching issue--whether state or federal officials have authority over Medicare Advantage plans. But a new state court ruling found that it's the feds who regulate Medicare Advantage marketing and advertising practices, not states, reports the Pittsburgh Business Times.
"It's like fourth grade," Judge Dan Pellegrini said of a court hearing Wednesday regarding the ongoing dispute between Pittsburgh health giants Highmark and the University of Pittsburgh Medical Center.
The Pennsylvania Attorney General and the departments of health and insurance want Highmark to expand its Medicare Advantage plans to include the University of Pittsburgh Medical Center within its network.
Pennsylvania Attorney General Kathleen Kane told Highmark that the state would seek enforcement in court because the insurer is not complying with the deal it struck with UPMC this past summer.
Highmark filed a lawsuit Wednesday against UPMC for allegedly overbilling the insurer by $300 million for cancer drugs. If Highmark wins, the case could be a "landmark and precedent-setting event" for insurers seeking to block providers from overcharging on procedures, medical billing expert Rebecca Reier told the Pittsburgh Post-Gazette.
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Highmark aired a TV ad saying it would lose thousands of jobs if UPMC doesn't sign a contract to join the insurer's provider network, and Pennsylvania officials are questioning the claim.
Two Pennsylvania House members want to require hospitals and hospital-owned doctor practices must contract with any willing insurer in newly introduced legislation--a direct result of the ongoing battle between Highmark and UPMC.
Highmark and its rival University of Pittsburgh Medical Center have been scolded by Pennsylvania officials for a "lack of professionalism" surrounding negative ads both companies have launched.