Nearly 2,000 Highmark Medicare Advantage (MA) members in western Pennsylvania switched insurers during this year’s extended open enrollment period. Most members signed up with big-name national carriers to ensure they would have in-network access to University of Pittsburgh Medical Center (UPMC) hospitals and physicians.
More than 1,600 of the Highmark MA members in Allegheny County took advantage of the special MA open enrollment period and signed up for an Aetna plan. Approximately 165 members joined United HealthCare during the first three months of 2019, according to the Pittsburgh Post-Gazette.
Industry experts told the publication that Highmark’s loss was likely due to UPMC’s plans to no longer contract with Highmark, requiring members of the insurer’s MA and other plans to pay upfront for UPMC services beginning July 1.
The long-standing feud between the two health care giants dates to 2012 when Highmark announced a plan to acquire the Allegheny Health Network. UPMC intended to cut Highmark members’ access to the organization’s providers in 2014, but the state intervened and imposed a five-year legal truce. This agreement ends in the Pittsburgh and Erie markets on June 30. Once the consent decree expires, Highmark members can still receive services from UPMC but will have to pay higher out-of-network costs in advance of their treatment.
Meanwhile, the Pittsburgh Post-Gazette reports that U.S. Sen. Bob Casey has asked the U.S. Department of Health and Human Services (HHS) to intervene and prevent the out-of-network pre-pay policy from taking effect and stopping UPMC to refuse care to out-of-network members. He also asked HHS to authorize a special enrollment period once the UPMC-Highmark consent decree expires. This will give Highmark MA members more time to find a plan that may better meet their needs.
In addition, Attorney General Josh Shapiro has filed for an appeal before the state Supreme Court to temporarily extend the consent decree. That hearing is scheduled for May 16, according to the publication.