How Does Highmark and UPMC’s new agreement affect access to UPMC with my Highmark plan that includes full in-network access to UPMC?

On, June 24th, 2019, the Pennsylvania Attorney General announced that he has brokered a relationship between Highmark and UPMC. The organizations agreed to a 10-year contract offering full in-network access to Highmark members in certain health products that include UPMC.

What does it mean for me right now?

  • In Western Pennsylvania, beginning on July 1st 2019, all Highmark members in broad access products like PPO Blue will have in-network access to all UPMC facilities and doctors.
  • Please see the listing below for additional details.

What products are considered “Broad Access Products?

  • Highmark offers a wide range of plans to our Clients and Members. If you have any confusion about your access to UPMC facilities, please contact 1-888 -258-3428 (TTY users may call 711) 8 a.m. to 8 p.m., Monday through Friday and we can answer any questions you may have.  Examples of Broad Access Products are listed below;
    • Large/National Products: PPO Blue, EPO Blue, Keystone Blue HMO, Direct Blue, Classic Blue, Signature 65
    • Small Group Products: PPO Blue, EPO Blue, Keystone Blue HMO, Premier Balance PPO, Balance PPO, Health Savings, PPO, High Deductible Qualified PPO, Keystone HMO, Shared Cost PPO
    • Individual Products: Please call us at 1-888-510-1084 (TTY users may call 711) 8 a.m. to 6 p.m., Monday through Friday.

What does this mean for UPMC emergency department (ED) access?

  • In an emergency situation, you should always go to the closest emergency room.
  • UPMC facilities would be considered in-network for emergency department services.

What about Children’s Hospital?

  • The new agreement includes a 10-year extension of the Children’s Hospital contract starting on July 1, 2019 including all affiliated pediatric practices.

What about Western Psychiatric Institute and Clinic?

  • The new agreement includes a 10-year extension of Western Psychiatric Institute and Clinic starting on July 1, 2019.

What does this mean to community hospitals?

  • Highmark is committed to its strategy of bringing access to community-based, close-to-home care for its members. Community hospitals will continue to play an important role in serving the needs of our members going forward. A contract with UPMC does not change that.

Will all of the planned AHN projects in the community continue?

  • These plans will continue. The enterprise is committed to driving change in how care is delivered at the community level.

Will this change Highmark’s strategy in investing in AHN and other health systems?

  • Not at all. We are focused on doing what’s right for our members and the community. This includes creating competition in health care, which we believe will help drive lower costs, higher quality and innovations in care.

Which UPMC Providers do I have access to?

  • Magee-Women’s Hospital of UPMC
  • UPMC East
  • UPMC Mercy
  • UPMC McKeesport
  • UPMC Passavant
  • UPMC Presbyterian Shadyside
  • UPMC St. Margaret
  • UPMC Hamot
  • UPMC Altoona
  • UPMC Bedford
  • UPMC Cole
  • UPMC Horizon
  • UPMC Jameson
  • UPMC Kane
  • UPMC Northwest
  • UPMC Somerset
  • Western Psychiatric Institute and Clinic of UPMC
  • Children’s Hospital of Pittsburgh of UPMC (including all affiliated pediatric practices)
  • UPMC Cancer Centers including UPMC Hillman Cancer Center in Shadyside
    • Mary Hillman Jennings Radiation Oncology at UPMC Shadyside
    • The Mario Lemieux Center for Blood Cancers
    • UPMC Hillman Cancer Center at Magee-Womens Hospital of UPMC
    • UPMC Hillman Cancer Center at UPMC East
    • UPMC Hillman Cancer Center at UPMC Hamot
    • UPMC Hillman Cancer Center (West 12th Street, Erie)
    • UPMC Hillman Cancer Center at UPMC McKeesport
    • UPMC Hillman Cancer Center at UPMC Mercy
    • UPMC Hillman Cancer Center at UPMC Natrona Heights
    • UPMC Hillman Cancer Center at UPMC Passavant McCandless
    • UPMC Hillman Cancer Center at UPMC Passavant North
    • UPMC Hillman Cancer Center at UPMC St. Margaret
    • UPMC Hillman Cancer Center in Bethel Park
    • UPMC Hillman Cancer Center in Monroeville
    • UPMC Hillman Cancer Center in Shadyside
    • UPMC Hillman Cancer Center in West Mifflin
  • Over 20 other UPMC and Community Hospital Cancer Centers including;
    • Butler Health System Medical Oncology
    • Butler Health System Radiation Oncology
    • Excela Arnold Palmer Cancer Center – Greensburg (Medical & Radiation Oncology)
    • Excela Arnold Palmer Medical Oncology – Mt. Pleasant
    • Excela Arnold Palmer Medical Oncology – Norwin
    • Grove City Medical Oncology
    • Heritage Valley Radiation Oncology – Moon
    • Heritage Valley Radiation Oncology – Beaver
    • John P. Murtha Regional Cancer Center – Johnstown (Radiation Oncology)
    • The Regional Cancer Center – Erie (Radiation Oncology)
    • Clair Cancer Center
    • IRMC Cancer Center
    • UPMC Cancer Center at UPMC Horizon Medical & Radiation Oncology Center
    • UPMC Cancer Center at UPMC Northwest
    • UPMC Hillman Cancer Center – Altoona (Medical & Radiation Oncology)
    • UPMC Hillman Cancer Center – Beaver (Medical Oncology)
    • UPMC Hillman Cancer Center – Greenville (Medical Oncology)
    • UPMC Hillman Cancer Center – Johnstown (Medical Oncology)
    • UPMC Hillman Cancer Center – Moon (Medical Oncology)
    • UPMC Hillman Cancer Center – New Castle (Medical Oncology)
    • UPMC Hillman Cancer Center – Uniontown (Medical Oncology)
    • UPMC Hillman Cancer Center – Washington (Medical Oncology)
    • UPMC Hillman Cancer Center – Windber (Medical Oncology)
    • UPMC Uniontown Hospital Radiation Oncology
    • Washington Health System Radiation Oncology
  • Doctors affiliated with hospitals above

 

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