UPMC, Highmark Resolve Dispute Over In-Network Rates
PITTSBURGH (AP) - Health insurer Highmark Inc. and the University of Pittsburgh Medical Center have resolved their dispute over which Highmark members can maintain in-network access to UPMC doctors and hospitals.
The state's largest health insurer and western Pennsylvania's largest hospital system announced the agreement on Thursday.
Under its terms, in-network access will be given to people with a chronic or persistent medical condition who received treatment at UPMC in 2013, 2014 and 2015. UPMC doctors will decide whether the patient's treatment qualifies as a "continuing course of treatment" and thus eligible for in-network rates.
Also, pregnant women receiving care at UPMC before Dec. 31 will continue to get in-network rates for maternity care, delivery and post-partum care.
The agreement does not apply to routine wellness or preventive care.
You can read the entire agreement online: http://insideupmc.upmc.com/wp-content/uploads/2015/11/UPMC-HIGHMARK-CONTINUITY-OF-CARE-SETTLEMENT-AGREEMENT1.pdf
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