On October 12, 2011, U.S. District Magistrate Cathy Bissoon of the United States District Court for the Western District of Pennsylvania issued an Opinion denying Highmark’s request for a preliminary injunction against UPMC, which injunction sought to restrain UPMC from publically discussing and stating that patients’ health care coverage could end as early as June 2012, while Highmark has been insisting that the one year run out clauses in the various contracts would extend that coverage until at least June 2013.

A key point in this case is that most of the hospital or facility contracts have run out clauses of various durations, but individual physician participation agreements with Highmark typically do not have general run out clauses, except for some exceptions for patients who are currently under care and for which termination would pose serious health risks. 

The point that is not addressed in the Opinion is that individual participation agreements between physicians and Highmark, as well as other third party insurance companies, are typically individual agreements between the physicians and those third party insurance companies, which might or might or might not be terminated by the physicians on 60 days notice.

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