If I am in the process of receiving a stem cell transplant and my physician will be considered out-of-network on July 1, 2019, will I need to transition my care to an in-network physician by July 1, 2019 to remain at an in-network cost level?

No. Since patients undergoing stem cell transplants require conditioning prior to the transplant, you will only be transitioned in-network when deemed clinically appropriate. Clinical appropriateness is determined on a case-by-case based through the medical review process.

Please contact My Care Navigator at 1-888-258-3428 for assistance with this process.

If it is clinically appropriate to transition your care to an in-network physician, and you decline, this service will be considered out-of-network. Please refer to your benefit plan booklet for more information. If you have a plan with out-of-network coverage, you will be responsible for your out-of-network cost sharing amount plus the difference between Highmark’s allowance and the provider charge, which is called balance billing. If you do not have a plan with out-of-network coverage, you will be responsible for the total provider charges.

Was this article helpful?

Related Articles