Highmark-insured seniors who use UPMC could get another chance to switch plans

Highmark-insured seniors and people with disabilities who use UPMC hospitals and doctors may get another chance to decide which insurance plan they want to have for the remainder of 2019.

U.S. Health Secretary Alex Azar informed U.S. Sen. Bob Casey by phone that the Centers for Medicaid & Medicare Services plans to announce a special enrollment period for about 1,300 of Highmark’s Medicare Advantage members in Western Pennsylvania who have visited UPMC facilities in the past three months, Casey told the Tribune-Review.

“Our letters will begin to mail to members this week and we are following CMS guidelines,” Highmark spokesman Aaron Billger confirmed. “Frankly, it is a relatively small number of members because our claims show that a majority of our Medicare Advantage members have already transitioned to in-network providers or they’ve told us they plan to do so.”

The move follows relaxed prepay rules announced by UPMC for most of Highmark’s patients on Medicare Advantage plans, privately offered alternatives to traditional Medicare. Those enrolled in Freedom Blue and Security Blue plans no longer will be subject to prepaying for treatment in full and will not be billed directly — even after UPMC and Highmark officially split insurance networks at the end of this month.

RELATED: Judge: UPMC-Highmark split set for June 30

The special enrollment period only applies to those two Medicare Advantage plans. Members of Highmark’s Community Blue HMO $0 monthly premium plan, which excludes UPMC facilities, will not be able to participate. It’s unclear precisely when the new enrollment option will be available.

Casey, D-Scranton, said the decision indicates that “federal officials at the highest level of government recognize that the care individuals and families in Western Pennsylvania receive is impacted by the fight over market share between UPMC and Highmark.”

“This news, paired with recent announcements that most Medicare Advantage policyholders will not have to prepay for their health care services, is a step in the right direction,” said Casey, who has been communicating with Azar about his concerns over the UPMC-Highmark split’s impact since April. “I will continue to urge UPMC and Highmark to formalize arrangements around prepayment and access to the Hillman Cancer Center.”

UPMC announced the prepay exceptions days before a Commonwealth Court showdown against Highmark and Pennsylvania Attorney General Josh Shapiro, who lost his push last week to persuade a judge to block the looming UPMC-Highmark breakup. Highmark had been asking for UPMC to reconsider the rule since it was announced Oct. 1. Shapiro filed legal action against UPMC in early February.

The abrupt concessions followed months of UPMC warning Highmark members it planned to enact a prepay rule as of July 1, including via robocalls and advertisements. Fear of the prepay rule prompted thousands of seniors to switch plans away from Highmark, with many going to national alternatives such as Aetna.

On Monday, UPMC submitted to Highmark its proposed term sheet related to patients who use any of Hillman Cancer Center’s 60 locations, UPMC spokesman Paul Wood said. UPMC has pledged that patients of any age and insurance plan — including those who enrolled via employer-backed plans or the federal health exchange — can continue receiving oncology treatment and follow-up care through Hillman Cancer Center at in-network rates beyond June 30.

Highmark officials are reviewing the proposal, Billger said Tuesday night.

RELATED: UPMC preserves access to Hillman Cancer Center for all Highmark-insured patients