Medicare Members and the Consent Decree

Is anything changing in 2018?

No. We’re happy to say, there’s no change to your current plan.

How does the latest Highmark UPMC ruling affect me?

It doesn’t affect you this year since there’s no change to your 2018 plan. So you can keep going to UPMC, plus the other great doctors and hospitals included in your plan, for the rest of 2018.

What does this mean for next year?

Some Western Pennsylvania UPMC facilities will be out of network in 2019. For a listing of these hospitals, please see below.

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.

What if my doctor becomes out-of-network?

If your doctor is no longer in-network, you can find a doctor that’s in-network or use the new See Any Provider Benefit for 2019. Visit medicare.highmark.com for an up to date listing of in-network providers or shop for a 2019 Medicare Advantage plan.

How can I find an in-network doctor?

We give you three 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
  • Take our Dr. Match Quiz and get paired up with an in-network doctor that suits your unique needs.
  • Stop by your local Highmark Direct health insurance store – To find a store near you, visit HighmarkDirect.com

What are out-of-network benefits?

Depending on your Medicare Advantage plan, you may be able to visit out-of-network doctors, hospitals or facilities as long as their Medicare-approved and agree to the terms of your plan.

Typically, these are the kinds of out-of-network options available to the different plan types:

1Out-of-network/non-contracted providers are under no obligation to treat Medicare Advantage plan members, except in emergency situations.

2HMO-POS plans may not cover all services at the point-of-service level. Cost share when using point-of-service benefits may be greater than at the in-network level.

3Some PFFS plans do not have a network. In those instances, there would be no network restrictions.

4Medigap has no network restrictions as long as the provider is accepting new Medigap patients.

What out-of-network benefits will I have in 2019?
All your plan benefits will be outlined in your Annual Notice of Change, which will arrive in a clear plastic bag in September. This will cover what type of plan you have as well as any changes to your in-network or out-of-network benefits. The good news is that your Highmark plan includes a
new See Any Provider Benefit for 2019, so you can continue to access any in- or out-of-network doctor. Plus, your plan benefits include set amounts for both in-and out-of-network services, so you always know what you’ll pay.
 
How do I get answers about my 2019 Medicare plan?
Appointments are available starting October 1, 2018, and we can meet with you by phone, at an in-person meeting, or at a Highmark Direct health insurance store near you. Visit
medicare.highmark.com.
 
What if I’m seeing a UPMC doctor for a chronic condition?
It’s usually best to transition your care to an in-network doctor. But many plans allow you to see in-network or out-of-network doctors for a set copay or coinsurance amount.
If you’re currently undergoing medically necessary treatment that will continue into 2019, you have the right to request that it’s not interrupted. And we’ll do our best to help make that possible.
 
Which UPMC hospitals will be part of my network in 2019?
In-Network
  • UPMC Altoona
  • UPMC Bedford
  • UPMC Cole
  • UPMC Horizon
  • UPMC Jameson
  • UPMC Kane
  • UPMC Northwest
  • UPMC Pinnacle Carlisle
  • UPMC Pinnacle Community Osteopathic
  • UPMC Pinnacle Hanover
  • UPMC Pinnacle Health Harrisburg Hospital
  • UPMC Pinnacle Lancaster
  • UPMC Pinnacle Lititz
  • UPMC Pinnacle Memorial
  • UPMC Pinnacle West Shore
  • UPMC Susquehanna Divine Providence
  • UPMC Susquehanna Lock Haven
  • UPMC Susquehanna Muncy Valley
  • UPMC Susquehanna Soldiers + Sailors
  • UPMC Susquehanna Sunbury
  • UPMC Susquehanna Williamsport
  • UPMC Children’s Hospital of Pittsburgh
  • UPMC Western Psychiatric Hospital
Out-of-Network

  • UPMC Magee-Womens Hospital
  • UPMC East
  • UPMC Hamot
  • UPMC McKeesport
  • UPMC Mercy
  • UPMC Passavant
  • UPMC Presbyterian
  • UPMC Shadyside
  • UPMC St. Margaret
Out-of-network/non-contracted providers are under no obligation to treat Freedom Blue PPO members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
 
I have Highmark Medigap insurance, will the end of the Consent Decree affect me?
No, your Medigap insurance (also known as Medicare Supplemental Insurance) will not be affected by the end of the Consent Decree. You can continue to see any doctor who accepts Medicare, including UPMC doctors. For more information about your Medigap policy and other Medicare options visit Highmark’s Understanding Medicare web page or call the number on the back of your insurance card.

Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, and HM Health Insurance Company depends on contract renewal.
 
Out-of-network/non-contracted providers are under no obligation to treat Freedom Blue PPO members, Security Blue HMO-POS and/or Community Blue Medicare PPO members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.
 
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Related searches: medicare upmc, medicare access to upmc, medigap, medicare part D, medicare advantage, freedom blue, security blue, medicare doctors

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