If you have a plan with out-of-network benefits and you use an out-of-network UPMC provider or facility, you may be billed by UPMC for the difference between the amount Highmark will pay, called a plan allowance, and the amount UPMC charges, called charges.
If you have no out-of-network benefits you will be responsible for all UPMC charges.
Generally, Highmark will make payment on the out-of-network allowances to you after subtracting the out-of-network cost sharing under your benefit plan.
- Which UPMC hospitals are included in my network under my Highmark plan after June 30, 2019?
- Can I keep seeing my UPMC doctor for my condition after June 30, 2019?
*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.