Dive Brief:
- A case in Pennsylvania filed against Pittsburgh-based insurer Highmark will move forward after a judge refused Highmark's motion for a restraining order this week. The US district judge ruled that federal courts cannot issue injunctions in state courts except in a small number of cases.
- The hearing stems from allegations by the state that Highmark violated a consent decree signed this summer with the University of Pittsburgh Medical Center that requires the insurer to include UPMC in-network in its Medicare plans. Since that time, Highmark has offered a low-cost Medicare Advantage plan without the provider as an in-network option.
- Attorneys for Highmark argued in court that the plan has been approved by the federal government. They also noted that the contract doesn't specifically denote Medicare Advantage plans in its language. The state's attorney general said that is an issue that will be heard in the upcoming hearings.
Dive Insight:
It looks as though the ongoing feud between the two Pittsburgh-based rivals will not be ending anytime soon. And Gov. Tom Corbett and Attorney General Kathleen Kane, who helped broker this summer's deal, appear to be ready to hold both organizations' feet to the fire until they learn to make nice.
Highmark spokesperson Aaron Billger told the Pittsburgh Post-Gazette that the organization is being held to a double standard by being required to include UPMC in-network in all of its Medicare plans. Highmark has said it offered the plan to all local health systems, but UPMC and a handful of other organizations declined due to low reimbursement rates. The organization is continuing to promote the plan, which is a zero-premium option meant as a lower-priced alternative to its other broad-network Medicare Advantage plans.