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Legal fight over Highmark/UPMC split goes before Pennsylvania Supreme Court

Decree, agreed to five years ago, was always set to expire June 30

Legal fight over Highmark/UPMC split goes before Pennsylvania Supreme Court

Decree, agreed to five years ago, was always set to expire June 30

BE EXTENDED BEYOND JUNE 30. CHIEF DEPUTY ATTORNEY GENERAL BART DELONE TOLD THE JUSTICES THAT UPMC’S CONDUCT IS THE REASON THE DECREE DEADLINE NEEDS TO BE PUSHED BACK. HE SPOKE OF A PATIENT WHO NEED IMMEDIATE BRAIN SURGERY BUT BECAUSE OF HER HIGHMARK INSURANCE WAS GOING TO BE FORCED TO PAY $65,000 UP FRONT AT UPMC. DELONE SAID THE REASON WE AR HERE IS UPMC IS NOT LIVING UP TO ITS OBLIGATIONS AS A PUBLI CHARIT HE ADDED THEY HAVE FOCUSED MOR AND MORE ON PROFIT AND LESS AN LESS ON PATIENT CARE. BUT JUSTICE MAX BAER QUICKLY RESPONDED THAT’S NOT THE ISSUE BEFORE US. UPMC ATTORNEY LEON DEJULIUS AGREED SAYING, THE ATTORNE GENERAL IS NOT THE REGULATOR O THE HEALTH CARE MARKETS. HE ALSO SAID FORCING OUT OF NETWORK PATIENTS TO PAY UP FRONT IS NOT UNUSUAL. LATER A UPMC SPOKESMAN DEFENDED THEIR CHARITABLE STATUS. WHAT ABOUT THE ARGUMENT THAT UPMC IS FAILING TO DO ITS JOB AS A PUBLIC CHARITY? >> THERE IS NO INSTITUTION IN PENNSYLVANIA THAT DOES MORE FOR ITS COMMUNITIES THAT UPMC DOES SPORTS COMMUNITY IN TERMS OF CHARITABLE DONATION AND IRS DEFINED COMMUNITY BENEFITS. PAUL: IT COULD BE SEVERAL WEEKS BEFORE THE SUPREME COURT RENDERS ITS DECISION. A DECISION THAT COULD HAVE PROFOUND IMPACT ON HUNDREDS THOUSANDS OF CONSUMERS IN WESTERN PENNSYLVANIA.
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Legal fight over Highmark/UPMC split goes before Pennsylvania Supreme Court

Decree, agreed to five years ago, was always set to expire June 30

July 1, 2019 is a date many have feared. That's when the consent decree between Highmark, UPMC and the Pennsylvania departments of Health and Insurance goes away.The decree, agreed to five years ago, was always set to expire June 30.Pennsylvania's Supreme Court heard arguments from UPMC and Highmark on their impending split Thursday. Thursday's arguments focused on whether UPMC's consent decree with Highmark should end June 30. UPMC said that is a hard deadline and it cannot be changed. The Attorney General's Office said it can and should be changed to protect consumers in western Pennsylvania. An attorney for Highmark appeared in court to support the attorney general's position to extend the consent decree. It is unclear when the court will make its decision but it is likely to be in the next few weeks. Watch the report from Action News investigator Paul Van Osdol in Harrisburg above. "How am I going to have that taken care of if I have to leave my doctors?" Evie Bodick asked Tuesday.Bodick, of Springdale, Allegheny County, receives cancer care at UPMC St. Margaret in Pittsburgh. She has made alternative plans for care but is still apprehensive about it, not wanting to leave the doctors she says saved her life.Bodick was part of a group that lobbied legislators in Harrisburg on Tuesday, trying to get them to support a law that would keep the status quo.The legislation is in line with Attorney General Josh Shapiro saying UPMC’s status as a not-for-profit and charitable organization means it must do more to act in the interests of taxpayers. Arguments are set for Thursday morning at the Pennsylvania Supreme Court. “With this bill, we can begin taking the regulatory steps necessary to protect competition and refocus health care on health,” said Rep. Dan Frankel, D-Squirrel Hill, regarding the legislative efforts.Advocates with the Pennsylvania Health Access Network estimate 200,000 customers will be impacted by the consent decree ending.With the exception of Children’s Hospital and Western Psychiatric, patients with Highmark plans will no longer be able to receive in-network care at UPMC facilities that are within the city of Pittsburgh.In a motion before the state Supreme Court hearing, UPMC has said that the June 30 date has been known for years. They also said the onus shouldn't be just on them to come up with a resolution, since Highmark and the health and insurance departments also agreed to the consent decree.UPMC did not respond for a request for comment for this story Tuesday.

July 1, 2019 is a date many have feared. That's when the consent decree between Highmark, UPMC and the Pennsylvania departments of Health and Insurance goes away.

The decree, agreed to five years ago, was always set to expire June 30.

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Pennsylvania's Supreme Court heard arguments from UPMC and Highmark on their impending split Thursday.

Thursday's arguments focused on whether UPMC's consent decree with Highmark should end June 30. UPMC said that is a hard deadline and it cannot be changed. The Attorney General's Office said it can and should be changed to protect consumers in western Pennsylvania.

An attorney for Highmark appeared in court to support the attorney general's position to extend the consent decree. It is unclear when the court will make its decision but it is likely to be in the next few weeks.

Watch the report from Action News investigator Paul Van Osdol in Harrisburg above.

"How am I going to have that taken care of if I have to leave my doctors?" Evie Bodick asked Tuesday.

Bodick, of Springdale, Allegheny County, receives cancer care at UPMC St. Margaret in Pittsburgh. She has made alternative plans for care but is still apprehensive about it, not wanting to leave the doctors she says saved her life.

Bodick was part of a group that lobbied legislators in Harrisburg on Tuesday, trying to get them to support a law that would keep the status quo.

The legislation is in line with Attorney General Josh Shapiro saying UPMC’s status as a not-for-profit and charitable organization means it must do more to act in the interests of taxpayers. Arguments are set for Thursday morning at the Pennsylvania Supreme Court.

“With this bill, we can begin taking the regulatory steps necessary to protect competition and refocus health care on health,” said Rep. Dan Frankel, D-Squirrel Hill, regarding the legislative efforts.

Advocates with the Pennsylvania Health Access Network estimate 200,000 customers will be impacted by the consent decree ending.

With the exception of Children’s Hospital and Western Psychiatric, patients with Highmark plans will no longer be able to receive in-network care at UPMC facilities that are within the city of Pittsburgh.

In a motion before the state Supreme Court hearing, UPMC has said that the June 30 date has been known for years. They also said the onus shouldn't be just on them to come up with a resolution, since Highmark and the health and insurance departments also agreed to the consent decree.

UPMC did not respond for a request for comment for this story Tuesday.