Consent Decree Updates

Because we value your relationship with us as a trusted producer of UPMC for Life products and share your commitment to and concern for Medicare beneficiaries, we want to bring your attention to an important matter. Effective June 30, 2019, the Consent Decrees that have governed certain aspects of the UPMC-Highmark relationship will expire. Calendar year 2018 will be the last full year that most UPMC hospitals and physicians in western Pennsylvania will be in-network for Highmark Medicare Advantage beneficiaries. 

Effective July 1, 2019, the following UPMC hospitals will be out-of-network for all Highmark Medicare Advantage products:

• Magee-Womens Hospital of UPMC
• UPMC East
• UPMC Hamot
• UPMC Horizon
• UPMC Kane
• UPMC McKeesport
• UPMC Mercy
• UPMC Passavant
• UPMC Presbyterian Shadyside (includes UPMC Montefiore and the Eye & Ear Institute, but does not include Western Psychiatric Institute and Clinic of UPMC)
• UPMC St. Margaret

We intend to share this information with Highmark Medicare Advantage subscribers now so that they have ample time – two full open enrollment periods - to make informed decisions about ways to preserve their in-network access to UPMC. Specifically, postcard mailers will be sent to UPMC patients this week who are enrolled in Highmark Select or Freedom Blue Medicare Advantage plans. We anticipate that you may be presented with a number of questions from beneficiaries who receive these cards and, to assist you in addressing those questions, we have prepared the attached list of “FAQs” along with recommended responses. For your convenience, we have also attached a copy of the aforementioned postcard as well.

Medicare beneficiaries with questions about this upcoming change can call the UPMC Health System Senior Line, which is run by and staffed with representatives from the UPMC clinical services division, at 855-946-8762. 
 
If you have any questions, please call your Account Manager.