You are using an older browser version. Please use a supported version for the best MSN experience.

Ruling: Highmark members lose UPMC access June 30

Pittsburgh Post-Gazette logo Pittsburgh Post-Gazette 6/14/2019 By Kris B. Mamula / Pittsburgh Post-Gazette
a tall building in a city © Provided by PG Publishing Co., Inc.

Highmark insurance members will no longer have discount access to many UPMC doctors after June 30, a Commonwealth Court judge ruled Friday in what is unlikely to be the last word in the bitter divorce of warring Pittsburgh-based health care systems.

Judge Robert Simpson ruled the consent decrees that guided business relations between Highmark and UPMC for nearly five years ends June 30, closing the doors to UPMC doctors for thousands of people in Western Pennsylvania who have Highmark health coverage.

An appeal of the decision to the state Supreme Court is expected — the second time in as many months the issue will come before the justices.

The state attorney general and Highmark officials “cannot state a cause of action for extension of the termination/expiration provision of the consent decrees,” Judge Simpson wrote.

Judge Simpson’s ruling comes eight days after UPMC unexpectedly announced that it would continue allowing in-network access for Highmark members after June 30 to three UPMC specialty hospitals, including Children’s Hospital in Lawrenceville. UPMC specialty hospital access for Highmark members had been a bitterly divisive issue in public hearings in the Pittsburgh area that were conducted in recent months by Allegheny County Controller Chelsa Wagner.

The state Supreme Court last heard an appeal of the agreement’s runout date on May 16 before ruling in a 4-3 decision May 28 to return the issue to Commonwealth Court to decide.

Judge Simpson heard two days of arguments in the case June 10-11 in Harrisburg.

The issue of when the consent decrees expire was first raised in February by Pennsylvania Attorney General Josh Shapiro, who filed a four-count civil lawsuit against UPMC for allegedly violating its nonprofit tax-exempt status in excluding Highmark members from access to institutions that public and philanthropic dollars helped build.

In court papers, UPMC lawyers said the attorney general was exceeding his authority in trying to get UPMC to accept Highmark members and replace UPMC’s board.

During the two days of hearings earlier this week, UPMC lawyer Leon F. DeJulius from the law office of Jones Day argued that the consent decrees were never intended to be extended indefinitely. Moreover, the attorney general had not provided independent evidence that the consent decrees’ modification clause included an extension.

“This was not a document negotiated for an indefinite extension,” Mr. DeJulius told the court. “There’s not one document that supports the attorney general’s case.”

In earlier testimony, executive deputy general James Donahue said the Highmark-UPMC agreement was the first time in his 34-year career with the attorney general’s office that an extension had been sought. However, the extension was justified by serving the public interest, where Highmark members — some critically ill — would be forced to find new doctors outside UPMC.

The attorney general’s lawsuit seeks a UPMC mandate to reach agreements with “any willing insurer,” an idea that legal experts say is without precedent.

Kris B. Mamula: or 412-263-1699


More from Pittsburgh Post-Gazette

Pittsburgh Post-Gazette
Pittsburgh Post-Gazette
image beaconimage beaconimage beacon