Highmark and UPMC

In 2012, UPMC announced it would no longer continue to contract with Highmark following Highmark’s proposed affiliation with health care provider Allegheny Health Network.

In 2014, Highmark and UPMC each entered into a Consent Decree with the Office of Attorney General, the Insurance Department and the Department of Health to provide clarity and certainty for consumers concerning in-network access for Highmark members to UPMC providers.

The Consent Decree allowed for access to certain unique or exception UPMC hospitals and providers and for certain groups of people (such as seniors) to continue receiving in-network treatment until the expiration of the Decrees on June 30, 2019.

Which counties are considered the Greater Pittsburgh Area?

The following counties are considered the Greater Pittsburgh Area:

  • Allegheny
  • Westmoreland
  • Washington
  • Beaver
  • Butler

The Greater Pittsburgh Area has limited UPMC access under the commercial contract negotiated in 2017.

Which counties are considered western PA, but not included in the Greater Pittsburgh Area?

The following counties are considered in western PA but outside of the Greater Pittsburgh Area:

  • Armstrong
  • Blair
  • Bedford
  • Cambria
  • Cameron
  • Centre (Western half only)
  • Clarion
  • Clearfield
  • Crawford
  • Elk
  • Erie
  • Greene
  • Fayette
  • Forest
  • Huntington
  • Indiana
  • Jefferson
  • Lawrence
  • McKean
  • Mercer
  • Potter
  • Somerset
  • Venango
  • Warren

Which counties are considered central PA?

The following counties are considered central PA:

  • Adams
  • Berks
  • Centre (Eastern half only)
  • Columbia
  • Cumberland
  • Dauphin
  • Franklin
  • Fulton
  • Juniata
  • Lancaster
  • Lebanon
  • Lehigh
  • Mifflin
  • Montour
  • Northampton
  • Northumberland
  • Perry
  • Schuylkill
  • Snyder
  • Union
  • York

Which counties are considered northeastern PA?

The following counties are considered northeastern PA:

  • Bradford
  • Carbon
  • Clinton
  • Lackawanna
  • Luzerne
  • Lycoming
  • Monroe
  • Pike
  • Sullivan
  • Susquehanna
  • Tioga
  • Wayne
  • Wyoming

 

*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.

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