recognizing that the purpose of the Consent Decrees was “to provide a measure of enduring certitude and security for health care consumers who were members of certain [J-60-2019] [MO: Wecht, J.] - 4 Highmark health care plans, that they would not incur significant costs in seeking treatment at UPMC facilities if UPMC followed through on its promise to terminate provider contracts for these plans at the end of 2014”
How later courts described this case
- recognizing that the purpose of the Consent Decrees was “to provide a measure of enduring certitude and security for health care consumers who were members of certain [J-60-2019] [MO: Wecht, J.] - 4 Highmark health care plans, that they would not incur significant costs in seeking treatment at UPMC facilities if UPMC followed through on its promise to terminate provider contracts for these plans at the end of 2014”
- stating, doctrine of ripeness seeks to avoid appellate court prematurely adjudicating controversy, thereby becoming entangled in resolving abstract or hypothetical issue, whenever party has yet to suffer concrete harm that can be alleviated through appellate review
- concluding Rule 311(a)(4) permitted an appeal as of right from an order that was “prohibitory in nature, in that it bar[red] both parties from taking further action . . . without obtaining approval from the Commonwealth Court”
- explaining that the use of the term "In-Network" obliged UPMC to "have a contract with Highmark that establishes negotiated rates for ... those in Medicare Advantage programs" (emphasis added)
Written by the judges who cited it.
The opinion
*152 Chief Justice SAYLOR,
concurring.
I join the majority opinion subject only to the following difference.
I agree with Mr. Justice Baer that there is less of an ambiguity in the Vulnerable Populations Clause of the Consent Decree than the majority opinion portrays, in light of his apt explanation that the third sentence simply is not illegal or meaningless if directed to participants in Medicare Parts A and B alone. See Dissenting Opinion, at 156-57 & 160-61,129 A.3d at 477 & 479. Nevertheless, I believe that there is still sufficient ambiguity to justify the inquiry, beyond the four corners of the Consent Decree, into the reason why the specific “continue to contract” language did not encompass Medicare Advantage.
In this regard, in the Consent Decree “Medicare” and “Medicare Advantage” are treated collectively as a single vulnerable-population segment—under the sub-clause “(i)”—in the first sentence of the Vulnerable Populations clause. This would seem to me to bolster the plausibility of the drafter(s) having used the terms “Medicare participating consumers” in the third sentence as a shorthand encompassing the Medicare units previously treated on a collective basis. Particularly in the landscape of the broader understanding, captured in the majority opinion, of the overarching intent to protect members of vulnerable populations—defined as including Medicare Advantage participants—and the parens patriae overlay of the case, I support the finding of ambiguity and the consequences flowing from this determination.