|By Alex Nixon, The Pittsburgh Tribune-Review|
|McClatchy-Tribune Information Services|
The problem has been particularly widespread with oncology practices, according to
What remains unclear, is whether patients will be on the hook for charges that are rejected by the insurer. UPMC spokesman
Highmark is the first insurer to take a public stand against the common practice that has been denounced for adding unnecessary costs to the health-care system and come under scrutiny by
"This practice has been going for a long time," Cassil said. "I think what is notable is why has it taken private insurers so long to stand up to the practice."
"This payment difference creates a financial incentive for hospitals to purchase freestanding physicians' offices and convert them to OPDs (outpatient departments) without changing their location or patient mix," the commission said in its recommendation that
In some cases, Highmark was billed
"For this particular type of problem, the biggest hitter is oncology care," he said. "It's particularly disturbing for patients" to experience those cost increases.
The company expects to reduce its claims by
Highmark's hospital system, Allegheny Health Network, is already taking steps to reduce added charges, Highmark spokesman
UPMC expects "we will be reimbursed for our services provided per the contractual arrangements until it expires at the end of the year," Wood said.
Highmark's reimbursement contract with UPMC ends
Several specialty and rural hospitals, along with some unique cancer services, will remain in-network after this year.
Fischer said Highmark is working to end the practice of charging higher fees and rates in doctors offices in all types of treatments and physician practices, not just oncology. That is primarily occurring through adding provisions when it negotiates reimbursement contracts with hospitals, he said.
"I think everyone is watching this," Fischer said. "I think this is the beginning of more accountability."
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