• UPMC dropping controversial 'prepay' rule for Highmark seniors

    Updated:

    PITTSBURGH - UPMC is planning to drop a controversial rule that required Highmark Medicare Advantage members to prepay for out-of-network services.

    The consent decree between the two competing local health giants expires at the end of the month.

    “Our intent is to ensure that Highmark members can receive emergency and other care that they need without being caught in the middle of billing issues created by their insurer,” UPMC spokesman Paul Wood said in a news release.

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    Highmark officials had asked UPMC to reconsider the prepay rule soon after it was announced on Oct. 1, 2018.

    "UPMC would have never proposed that prepay requirement back in October had we not had experiences with Highmark for being such a poor payer, for under reimbursing where contracts require, for changing and simply not paying their bills," Wood said in an interview with Channel 11.

    But Highmark Allegheny Health Network says it’s always paid UPMC for its out-of-network Medicare Advantage patients and never intended to stop after the consent decree between the health networks is scheduled to end on June 30.

    “We are glad UPMC is now in agreement with us. We have long said that UPMC’s prepay actions were unnecessary and unprecedented. It’s a shame they promoted this in the first place,” Highmark spokesman Aaron Billger said
     

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