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 can always go to any hospital for emergency care, including UPMC.

How will my coverage work if my doctor becomes out-of-network?

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. If you have any questions about your options after you review your 2019 plan benefits, please call us.

Out-of-network/non-contracted providers are under no obligation to treat Freedom Blue PPO members, except in emergency situations.

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.

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.

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
  • Visit DrMatchQuiz.com
  • Stop by your local Highmark Direct health insurance store – To find a store near you, visit HighmarkDirect.com

Which UPMC hospitals will be part of my network in 2019?

In-Network

  • UPMC Altoona
  • UPMC Bedford Memorial
  • UPMC Cole
  • UPMC Horizon
  • UPMC Jameson
  • UPMC Kane
  • UPMC Northwest
  • UPMC Pinnacle Carlisle
  • UPMC Pinnacle Community
  • UPMC Pinnacle Hanover
  • UPMC Pinnacle Harrisburg
  • 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 Memorial
  • UPMC Susquehanna Sunbury
  • UPMC Susquehanna Williamsport Regional Medical Center
  • UPMC Children’s Hospital of Pittsburgh
  • Western Psychiatric Institute and Clinic of UPMC

Out-of-Network

Magee-Womens Hospital of UPMC

  • UPMC East
  • UPMC Hamot
  • UPMC McKeesport
  • UPMC Mercy
  • UPMC Passavant
  • UPMC Presbyterian 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 webpage or call the number on the back of your insurance card.

Highmark Choice Company and Highmark Senior Health Company are Medicare Advantage plans with a Medicare contract. Enrollment in Highmark Choice Company and Highmark Senior Health Company depends on contract renewal. The provider network may change at any time. You will receive notice when necessary. Highmark Blue Cross Blue Shield, Highmark Choice Company, and Highmark Senior Health Company are independent licensees of the Blue Cross and Blue Shield Association.

H3957_H3916_18_0662 Accepted

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