Important Clarification About Provider Networks In Central Pennsylvania
Health Insurers across the nation are continuing to grapple with ways to help keep health plans affordable in the Individual Affordable Care Act (ACA) market. One of the most effective ways that insurers have helped consumers better manage costs associated with their health insurance products is to create options that have a more narrow network of health care providers. Highmark has taken this approach in an effort to manage the cost of care for consumers in central Pennsylvania.
The intent of this Alert is to clarify our recent decision to make provider network adjustments in the Individual ACA market.
Effective January 1, 2018, UPMC Pinnacle Hospitals are out-of-network for all of Highmark’s Individual ACA products, with the exception of UPMC Pinnacle Carlisle. All of the UPMC Pinnacle Hospitals were offered in–network participation in the products, but unfortunately, they declined. As we all know, managing the costs of the Individual ACA marketplace products has been a challenge nationwide and it is critical to have only high value providers in these products.
Conversely, continuing through the 2018 contract year, UPMC Pinnacle Hospitals will remain in-network for Highmark’s Medicare Advantage products: Community Blue Medicare HMO, Community Blue Medicare PPO, and Freedom Blue PPO.
It is important to also note that Highmark and Pinnacle have recently extended their other commercial contract for seven years, ensuring that members who received their employee benefits through small groups, mid-size groups and large groups will continue to have Pinnacle as a participating provider in their products.
Members with questions are encouraged to call customer service or visit a Highmark Direct store. If you have any questions about this Alert, or any of Highmark’s provider networks, please contact your Highmark Sales Executive or Client Manager.
