Highmark reached an agreement to keep Rothman Orthopaedics in network after Oct. 1
Highmark and Rothman had a dispute about the use of out-of-network physician assistants by a small number of Rothman surgeons.
Highmark reached an agreement to keep Rothman Orthopaedics in network for Pennsylvania customers of Highmark Blue Shield plans and federal employee health programs after Oct. 1, the two companies said Wednesday.
The Pittsburgh-based insurer had issued a termination notice over the summer, claiming that about a half-dozen Rothman surgeons were abusing a federal process designed to protect patients from unforeseen out-of-network bills.
The dispute centered on the use of out-of-network physician assistants by Rothman surgeons who do not have residents or fellows working for them and need help treating patients.
Highmark said the practice violated a contract that took effect at the beginning of last year and that the use of arbitration under the federal No Surprises Act generated extraordinarily large payments for the physician assistants.
The physician assistants worked for separate company that Rothman, a practice, had no control over, a Rothman official said earlier this month.
