Do I have to transition my care to an in-network cancer center?

If I am currently in treatment at a UPMC cancer center that will become out-of-network after July 1, 2019, do I have to transition my care to an in-network cancer center?

In general, you should transition your care to an in-network cancer center by July 1, 2019 to remain at in-network cost-sharing. The timing of your transition may depend on your treatment plan, but we recommend you start planning your transition to a network doctor now to ensure a smooth care transition and to enjoy the greatest value of your Highmark plan.

If your plan has out-of-network benefits after the Consent Decree expires, and you continue to use out-of-network cancer centers after July 1, 2019, you will be responsible for out-of-network cost-sharing and the difference between the out-of-network allowance and the doctor and facility charges. If you do not have out-of-network benefits, and decline to transition to a qualified network doctor, you will be responsible for all doctor and facility charges.

If I am a cancer patient in remission but still in a long-term course of care with a UPMC doctor that will be considered out-of-network on July 1, 2019, do I need to transition my care in-network to remain at a network cost?

Yes. You should transition your care to one of our highly qualified in-network doctors by July 1, 2019 to remain at a network cost-sharing and gain the greatest benefits from your Highmark plan. If you decline to transition to a network doctor and have out-of-network benefits, you will be responsible for out-of-network cost-sharing and the difference between the out-of-network allowance and the doctor and facility charges, which can be significant. If you do not have out-of-network benefits, and decline to transition to a qualified network doctor, you will be responsible for all doctor and facility charges.

*This answer is applicable to Commercial and ACA plans only. For questions about how the end of the Consent Decree impacts Medicare Advantage plans, please call the number on the back of your member identification card.

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