Some Western Pennsylvania UPMC facilities will be out of network in 2019. For a listing of these hospitals, please see below.
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.
Should you receive notification that your doctor is no longer in-network for your insurance plan, you have options to consider:
- If you are a Highmark Freedom Blue or Security Blue Medicare Advantage member, you have a See Any Provider Benefit that gives you the flexibility to access any primary care physician or specialist that accepts Medicare, even those outside of your network.
- In order to use your See Any Provider Benefit, the doctor must be willing to accept you as a patient. As with any in- or out-of-network service, we want to make sure you know what to expect. So we encourage you to call us before scheduling out-of-network care so we can help you navigate the process, including explaining your covered benefits, reviewing medical necessity, and outlining how claims are paid.
- Visit https://www.highmarkbcbs.com/home/ for our provider directory to check if your doctor is in-network.
Visit https://www.highmarkbcbs.com/home/ for our provider directory to check if your doctor is in-network.
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 HighmarkDirect.com
- Take our Dr. Match Quiz and get paired up with an in-network doctor that suits your unique needs.
- UPMC Children’s Hospital of Pittsburgh
- UPMC Western Psychiatric Hospital
- UPMC Altoona
- UPMC Bedford
- UPMC Horizon (both campuses)
- UPMC Jameson
- UPMC Kane
- UPMC Northwest
- UPMC Somerset
- UPMC Cole
- UPMC Pinnacle Carlisle
- UPMC Community Osteopathic in Harrisburg
- UPMC Pinnacle Hanover
- UPMC Pinnacle Harrisburg
- UPMC Pinnacle Lancaster
- UPMC Pinnacle Lititz
- UPMC Pinnacle Memorial in York
- UPMC Pinnacle West Shore in Mechanicsburg
- UPMC Susquehanna Divine Providence in Williamsport
- UPMC Susquehanna Lock Haven
- UPMC Susquehanna Muncy Valley
- UPMC Susquehanna Soldiers + Sailors in Wellsboro
- UPMC Susquehanna Sunbury
- UPMC Susquehanna Williamsport Regional
- UPMC Magee-Womens Hospital
- UPMC East
- UPMC Hamot
- UPMC McKeesport
- UPMC Mercy
- UPMC Passavant
- UPMC Presbyterian
- UPMC Shadyside
- UPMC St. Margaret
Many of our plans offer you the freedom to access out-of-network doctors and hospitals across Pennsylvania and around the country. Other plans include defined networks that do not allow you to see out-of-network providers. Highmark’s Medicare Advantage Security Blue HMO-POS and Freedom Blue PPO both offer rich out-of-network benefits that allow you to see any doctor willing to accept you as a patient at a similar cost.
As with any in- or out-of-network service, we want to make sure you know what to expect. So we encourage you to call us before scheduling out-of-network care. We can help you navigate the process, including explaining your covered benefits, reviewing medical necessity, and outlining what you may need to pay.