How Does Highmark and UPMC’s new agreement affect access to UPMC with my Medicare Advantage plan?

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.

Is my current plan affected by this new agreement?

  • If you have Freedom Blue/Security Blue Products;
    • As a Freedom Blue PPO or Security Blue HMO-POS member, you have the freedom to access doctors and hospitals across Pennsylvania and around the country. The new agreement with UPMC means that the UPMC doctors and facilities that were in-network when you signed up for your 2019 plan will remain in-network meaning there are no changes for you.
  • If you have Community Blue Products;
    • As a Community Blue member, you are enrolled in a high-quality, lower-cost Medicare Advantage plan that offers great benefits. The new agreement with UPMC does not have any impact on Community Blue Medicare Advantage members, so you don’t have to make any changes.
    • Your provider network is not changing — You’ll still have access to the same providers that were in network when you signed up for your 2019 plan. This means the UPMC physicians and facilities that are out of network, remain out of network.
  • If you have Medigap Products;
    • Consumers with Medicare supplemental insurance (Medigap) plan have access to all providers who accept Medicare, including UPMC. Highmark’s Medicare supplemental policies do not have networks. Therefore, you never have to worry if you’re doctors or facilities are in-network or out-of-network.

How do I get answers about my 2019 Medicare plan?

What if I already left Highmark, but want to come back?

You can call us at 1-866-871-7710 (TTY users may call 711), 8 a.m. to 8 p.m., seven days a week.  In just a few months, the Medicare Advantage Annual Enrollment period begins, where you’ll be able to learn about Highmark’s coverage for 2020 and sign up for a new plan.  In the meantime, we can help you get set up with an appointment so we can make the process as easy as possible.  We would love to have you back as a Highmark member.

Can I still go anywhere for emergency care?

Yes. You’re always covered when it matters most. When there’s an emergency, your Highmark Medicare plan always covers your care the same as in-network care, no matter where you go. This includes all UPMC facilities.

This is also true if the Emergency Department admits you. Your Highmark Medicare plan will cover your emergent inpatient care the same as in-network care up through the time you are discharged.

How can I find an in-network doctor?

Visit https://www.highmarkbcbs.com/home/ for our provider directory to check if your doctor is in-network. Please note, our directory is in the process of being updated based on the new agreement with UPMC.  Prior to making an appointment with a UPMC doctor please call the number on the back of your member ID card.

Also, we give you easy ways to find your ideal doctor:

  • Call 1-866-871-7710 (TTY users may call 711), 8 a.m. to 8 p.m., seven days a week
  • Stop by your local Highmark Direct health insurance store – To find a store near you, visit https://www.highmarkdirect.com.
  • Take our Match Quiz and get paired up with an in-network doctor that suits your unique needs.

I already switched my doctor, do I need to switch back?  

If you transitioned your care to one of our many in-network providers, there is no need to make any changes.

You can always visit https://www.highmarkbcbs.com/home/ for our provider directory, call 1-866-871-7710 (TTY users may call 711), 8 a.m. to 8 p.m., seven days a week, or visit a Highmark Direct health insurance store to check if your doctor is in-network. Please note, our directory is in the process of being updated based on the new agreement with UPMC.  Prior to making an appointment with a UPMC doctor please call the number on the back of your member ID card.

 

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