Highmark and UPMC

When UPMC ended most of its commercial contracts with Highmark, the Governor’s Office facilitated a Consent Decree to allow limited and temporary access to UPMC in certain circumstances through June 30, 2019. The Consent Decree is ending. This website provides information that will help you navigate your path forward.

After the Consent Decree expires on June 30, 2019, Highmark and UPMC will follow a new commercial contract negotiated in 2017 that allows for continued covered access to certain UPMC doctors and hospitals in Erie and western PA. Western PA is divided into two areas — The Greater Pittsburgh Area and all other counties in western PA. See below for the counties in each service area.

The specific terms of coverage will be according to your benefit plan, and covered claims from UPMC providers may process at a lower level of benefits under certain plans.

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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