Judge rules against UPMC & Highmark consent decree extension
(C) Wikimedia Commons (Michael G. White)

Judge rules against UPMC & Highmark consent decree extension

A Commonwealth Court judge ruled Friday that the agreement between two Pittsburgh health systems, the University of Pittsburgh Medical Center (UPMC) and Highmark Health (Highmark) cannot be extended past its June 30, 2019 expiration date. As a result, Highmark insurance members will no longer have discounted access to UPMC facilities and network; triggering higher costs in health care.

The relationship between UPMC and Highmark has been increasingly contentious, as they are the two largest health plan providers within Pennsylvania. In 2014, the Commonwealth Court ordered UPMC and Highmark to enter into an agreement, the consent decrees, detailing how the two entities were to interact. The agreement specifically allowed Highmark insurance members to use UPMC’s facilities at a discounted rate until June 30, 2019.

Concerned with the impending expiration date, Pennsylvania Attorney General Joshua Shapiro filed a lawsuit against UPMC for various claims, including their refusal to extend the expiration date. UPMC responded by suing Shapiro for exceeding his authority in extorting them to sign the new agreement with a lawsuit. Shapiro’s case moved through the court system, reaching the Pennsylvania Supreme Court, who in turn remanded back to Commonwealth Court to decide.

At present, Commonwealth Court Judge Robert Simpson refused to extend the expiration date. In his ruling, Judge Simpson explained that a clause in the 2014 consent decree prevented extension of the expiration date. Judge Simpson went further to note that both parties (Highmark and UPMC) had “outward and objective manifestations of assent” which support the interpretation that the expiration date was never meant to be extended.

Judge Simpson’s ruling comes days after UPMC announced it would continue allowing Highmark member in-network access after June 30 to three UPMC hospitals.

The decision is expected to be appealed to the State Supreme Court. In a tweet, Shapiro indicated he plans to appeal Simpson’s ruling.