How Does Highmark and UPMC’s new agreement affect access to UPMC with my Highmark plan that includes some 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?

  • Commercial members may be enrolled in high-quality lower cost high performing narrow network products such as Community Blue Flex or Connect Blue . In Western Pennsylvania, members in these products will have access to some, but not all, UPMC facilities and doctors on July 1st, 2019. This is very similar to access prior to the negotiation of this new agreement.
  • Certain services (like exception hospitals and some community oncology services) will be in-network. See list below.
  • Other facilities and services (like UPMC Hillman and UPMC Passavant) will remain out-of-network after July 1 for these products. See list below.

What products are considered “High Performing, Narrow Network Products”?

Highmark offers a wide range of products 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 High Performing, Narrow Network Products are listed below;

  • Large/National Products: Community Blue PPO/EPO/HMO, Community Blue Flex EPO/PPO, Connect Blue, Conemaugh Region Flex Blue, Community Blue Flex: Pennsylvania Mountains Healthcare Region
  • Small Group Products: Community Blue PPO, Premier Balance PPO a Community Blue Flex Plan, Balance PPO a Community Blue Flex Plan, Health Savings PPO a Community Blue Flex Plan, Connect Blue EPO, Flex PPO Pennsylvania Mountain Healthcare Region a Community Blue Flex Plan
  • 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. As part of the agreement between Highmark and UPMC, reasonable out of network rates were negotiated that will be accepted as payment in full. You will only be responsible for any applicable deductible, co-insurance, or copayment. Any follow up care coordinated with in-network facilities and providers would also be considered in-network. Please contact us for any questions you may have to ensure that your follow up care is with in-network providers. Highmark can also help to provide you with information on when you may want to consider using Urgent Care Centers or your in-network provider’s office.

What about Children’s Hospital?

The new agreement includes an extension of the Children’s Hospital contract for 10 years 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 to 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?
    • Prior to the negotiated contract, your high performing, narrow network plan would have provided very limited access to UPMC doctors or hospitals. You will now have in-network access to a number of UPMC doctors and hospitals after July 1, 2019. The UPMC hospitals and other providers listed below will be in-network for you starting July 1:
      • 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)
      • Doctors affiliated with the Hospitals listed above

    Which UPMC Joint Ventures do I have access to at Community Hospitals?

    • The UPMC hospitals and other providers listed below will be in-network for you:
      • 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

    Which UPMC Providers remain out of network?

    • The hospitals listed below will remain out-of-network after July 1st for our high performing narrow network products:
      • Magee-Women’s Hospital of UPMC
      • UPMC East
      • UPMC Mercy
      • UPMC McKeesport
      • UPMC Passavant
      • UPMC Presbyterian Shadyside
      • UPMC St. Margaret
      • UPMC Hamot
      • UPMC Hillman Cancer Centers;
        • 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

 

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