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Big Win For UPMC As Consent Decree With Highmark To End June 30

PITTSBURGH (KDKA) -- For years, the medical giant UPMC has tried to end its overall relationship with Highmark, and it's likely to happen June 30, thanks to Commonwealth Court Judge Robert Simpson.

"We think it's the right decision. This is what the parties agreed to five years ago. This is what we've all been talking about for five years," UPMC chief communications officer Robert Simpson told KDKA money editor Jon Delano on Friday.

"It does feel like there's a sense of finality," Simpson added.

In 2014, UPMC, Highmark, and the Attorney General negotiated a five-year consent decree allowing Highmark customers lower-cost, in-network medical services at UPMC until June 30, 2019 -- but not after that.

As the deadline approached, Attorney General Josh Shapiro and Highmark argued in court that the deadline could be extended because of a modification provision in the consent decree.

On Friday, the judge said no to that.

"The modification provision was not intended to nullify the short, specific, unambiguous termination/expiration provision in the preceding paragraph, as that provision was a core principle of the agreement first addressed in the term sheets, and was expressly negotiated by the parties," Judge Simpson wrote in his 14-page opinion.

KDKA's Jon Delano On What's Next In The UPMC-Highmark Battle:

Neither the attorney general nor Highmark would appear on camera, but both issued statements.

"This ruling is not a defeat in preserving health care choice for consumers, but rather just a temporary setback," said Aaron Billger, Highmark spokesperson.

Noted the Attorney General: "Make no mistake -- our work here is not done."

"While we are disappointed in Judge Simpson's ruling, I won't quit on the people of western Pennsylvania and we will continue to take steps to restore fairness to the healthcare system and give people access to the institutions their tax dollars built."

UPMC's Wood said those who want to use UPMC services have already picked other insurance companies to replace Highmark.

"Most everybody who wants to continue to use their UPMC doctors, continue to use UPMC hospitals, has made the choice and switched their insurances accordingly," said Wood.

"We have insurance contracts with Aetna, Cigna, United Healthcare, UPMC Health Plan obviously."

After June 30, Highmark customers can still use doctors and services at in-network prices at three unique facilities in which UPMC is the principal provider.

Those include pediatric services at Children's Hospital, oncology services at Hillman Cancer Institute, and mental health treatment at Western Psychiatric Hospital.

In a statement, Highmark seemed to warn that UPMC may not be counted on to maintain this access to Highmark customers.

"To protect our health plan members and patients, we need to secure contract language and agreements so that UPMC's practices align with their verbal commitments," noted Highmark's Billger.

The attorney general already has ongoing legal actions against UPMC, accusing the company of violating the state's public charities law and the unfair trade practices law, and he said he will announce next week any further legal action.

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