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WHAT THIS MEANS TO YOU
The recent agreement facilitated by the State means Highmark members will have access to most UPMC providers
even after the current contracts expire on December 31, 2014. Take a few minutes to look through the information
below to make sure you have all the facts about your coverage for 2015.
Access to UPMC for Cancer Patients
If you or a family member is receiving cancer care from UPMC
providers now – or if you need cancer care in the future – you
have access on an in-network basis to all UPMC services,
facilities, doctors and joint ventures (with other hospitals)
for oncology care... and for any illnesses/complications
resulting from cancer treatment, including (but not limited to)
endocrinology, orthopedics and cardiology.
Cancer patients will work with their doctor to determine the
best provider to treat them. Highmark wants to ensure that
you have a choice so that you and your family get the best care
for your specific condition.
“Continuation of Care” for Members in Treatment Now
If you or a family member is in the midst of a course of
treatment with any UPMC provider – no matter what the
diagnosis – you can continue to see that provider, if you wish.
It’s your choice, and you’ll want to work with your doctor
to make the right decision about continuing care with your
current provider.
A “Safety Net” for All Members
If you don’t have any specific health problems but you have
seen a UPMC physician in 2014, you’ll have extra time to change
providers. For example, you may have a UPMC primary care
physician or ob/gyn. Or you may have seen a UPMC specialist
recently.
If you received care in 2014 from a UPMC provider and cannot
find an alternative provider in your area, you can continue to
receive care from that same provider in 2015 on an in-network
basis. After 2015, you’ll need to change providers if you want
care on an in-network basis. If you choose to stay with a UPMC
provider after 2015, any care you receive from that provider will
be paid at the out-of-network benefit level.
YourNetwork2015.com
In case of an emergency, you’re covered
If you receive care at any UPMC emergency room – including
UPMC hospitals – it will be covered on an in-network basis.
This includes not only the emergency room visit but also any
inpatient admissions and continued care. As is the practice
now, patients and their doctors will determine if and when a
transfer to another facility may be appropriate.
UPMC Hospitals: Which will be In-Network in 2015?
Some UPMC providers will continue to be in-network in 2015.
Special Protection if You Receive Out-of-Network Care from UPMC
If you do not qualify for in-network access to UPMC providers
because you need cancer care, are in the midst of a course
of treatment or received care from a UPMC provider in 2014
and you choose to receive care from an out-of-network UPMC
provider, you will be responsible for the out-of-network
cost-sharing according to your benefit design. UPMC can only
“balance bill” you the difference between our payment amount
and 60 percent of their actual charge.
In Allegheny County:
• Children’s Hospital of Pittsburgh of UPMC
• Western Psychiatric Institute and Clinic
• UPMC Mercy
• Hillman Cancer Center
In other counties in western PA:
• UPMC Altoona
• UPMC Bedford
• UPMC Hamot and its affiliate Kane Community Hospital
• UPMC Horizon
• UPMC Northwest
Any physicians who have admitting privileges at any of the
UPMC hospitals listed above will also be in the Highmark network in 2015.
UPMC Hospitals: Which will be Out-of-Network in 2015?
Starting January 1, 2015, the following UPMC hospitals will be
out of network:
• Magee-Womens Hospital of UPMC
• UPMC East
Go online – to YourNetwork2015.com – to learn more
To confirm if your physician will be in the Highmark
network in 2015 or to find a new provider, just visit
YourNetwork2015.com. There you’ll find an online
directory that will let you search for doctors that are likely
to be in the Highmark network as of January 1, 2015.
Or Call Us for the Help You Need
If you have questions about whether you can keep your
current doctor – or you’d like help finding a new doctor
– you can call myCare Navigator at 1-888-BLUE-428 or
the Member Service number on your Highmark ID card.
Highmark representatives can confirm if a doctor will be
in network in 2015, help you find a new doctor (if you
need one), even make an appointment and help transfer
medical records.
• UPMC McKeesport
• UPMC St. Margaret
• UPMC Passavant
• UPMC Presbyterian-Shadyside
Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield
Association. Blue Shield and the Shield symbol are registered service marks of the
Blue Cross and Blue Shield Association. Highmark is a registered mark and myCare
Navigator is a service mark of Highmark Inc.
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