State says Highmark’s new health plan violates consent agreement

The Pennsylvania State Attorney General Office and the departments of Health and Insurance are asking the Commonwealth Court to order Highmark Inc. to allow participants in its new plan for seniors use doctors working at the University of Pittsburgh Medical Center (UPMC).

The court has been asked to stop the Pittsburgh health insurer, Highmark, from marketing limited network Medicare Advantage products that do not include doctors from UPMC and to warn brokers that by selling the plans they are at risk of breaking the state’s Unfair Insurance Practices Act.

UPMC has the largest network in western Pennsylvania, with a total of 22 hospitals.

Last week Highmark introduced its new Medicare Advantage “Community Blue” product line which is in “selective compliance” by violating a consent agreement that was made this summer between the two health giants.

Medicare Advantage policies are sold by private insurers for senior citizens.

The new Community Blue plan physician network excludes UPMC hospitals, in addition to those of Butler Health System, and Excela Health.

The agencies said:

“Highmark should not be permitted to fail to provide the agreed protections for the vulnerable population due to its unilateral interpretation of the consent decree and instead should be found to be in breach of the consent decree.”

However, Aaron Billger , a spokesman for Highmark, said the consent agreement has not been violated.

Billger said:

“We believe that this is the wrong action at the wrong time for seniors. The commonwealth, frankly, is seeking to dictate product design here.”