Yes. It’s always best to transition your care to an in-network provider in order to maximize the benefits of your Highmark insurance plan. If you choose to see an out-of-network doctor or hospital, you may incur additional financial responsibility.
If you have a plan with out-of-network benefits and you use an out-of-network UPMC provider or facility, you may be billed by UPMC for the difference between the amount Highmark will pay, called a plan allowance, and the amount UPMC charges, called charges.
If you have no out-of-network benefits you will be responsible for all UPMC charges.
- Which UPMC hospitals are included in my network under my Highmark plan after June 30, 2019?
- Where can I receive cancer care from a UPMC doctor under my Highmark plan after June 30, 2019?
*This answer is applicable to Commercial and ACA plans only. For questions about how the end of the Consent Decree impacts Medicare Advantage plans, please call the number on the back of your member identification card.