Governor Wolf Announces Highmark Agrees to Pay all Unpaid Claims Filed by UPMC since January

May 06, 2015

Harrisburg, PA – Governor Tom Wolf today announced that Highmark has agreed to pay all outstanding medical claims filed by UPMC providers and facilities since January 1, 2015. Highmark has agreed to consider these claims as in-network and will pay the approximate 30,000 outstanding claims. This action ensures consumers will not be balance billed for their medical care.

“This is a major win for consumers, and I applaud Highmark for working with Commissioner Miller and the Pennsylvania Insurance Department to resolve this matter,” said Governor Wolf. “My focus is protecting consumers caught in the dispute between Highmark and UPMC, and I have urged both companies to do the same. Just last week, I announced that my administration, working with the Attorney General, filed a motion in Commonwealth Court to protect seniors from losing access to their doctors as a result of UPMC’s decision to cancel its Medicare Advantage contract with Highmark and to force both sides into arbitration.”

Since January, more than 900,000 insurance claims have been filed on behalf of Highmark insurance customers, who received care from UPMC providers and facilities. Nearly all of the claims, approximately 97 percent, were processed and paid as expected. Approximately 30,000 of these claims, or roughly 3 percent, were not paid as a result of the ongoing dispute between Highmark and UPMC. Today’s announcement removes any uncertainty about claims filed with Highmark for UPMC-provided care from January 1, 2015 through today.

Governor Wolf has been resolute in standing up for consumers in this dispute. In January, Governor Wolf announced that Highmark will continue to cover pregnancy and related care at Magee-Womens Hospital of UPMC in 2015 for women who became pregnant in 2014, despite it no longer being in their network of providers. Just last week, the governor said that his administration, working with the Office of Attorney General, filed a motion in Commonwealth Court to protect more than 180,000 seniors from losing access to their doctors as a result of UPMC’s decision to cancel its Medicare Advantage contract with Highmark. The motion also petitions the court to force the two sides into arbitration to settle outstanding disputes to end the confusion for consumers.

MEDIA CONTACT: Jeff Sheridan – 717.783.1116

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