Highmark has a long history of offering a broad
range of products for our Medicare members including both
in-network and out-of-network benefits and remains committed
to providing convenient, affordable access to local
health care providers and while traveling. We realize network
changes on our Medicare products may create an increase in
questions from your clients. To assist you, below are a few
important reminders for frequently asked questions.
Important
Reminders:
- Highmark
has expanded
out-of-network benefits for Freedom Blue
PPO and Security Blue HMO-POS Medicare Advantage
plans to make it easier for members to access care.
- There
is no
change
for
Highmark's Community Blue Medicare HMO and PPO or
Medigap Blue members.
- Highmark
is hosting more than 90 educational member
events
across
the region; members can sign up for a meeting on our
Digital Reservation Site, reservations.highmark.com.
Can UPMC require members to pay
the full amount before they schedule?
It
is true that Medicare-accepting providers are allowed to
request payment before seeing a patient, but across the
nation, providers have historically billed us directly for
Medicare Advantage out of network care.
On
October 2, UPMC declared they will require payment in full
and in advance from Highmark Security Blue and Freedom Blue
members for services scheduled with them after June 30, 2019
when using services on an out-of-network (OON) basis. We are
reaching out to UPMC to clarify the details surrounding their
recent announcement.
As an important reminder:
- Freedom Blue
PPO members will
be responsible for the same copay in- or out-of-network
care for medical services including PCPs, specialists,
OP surgery, IP admission, etc.
- Security Blue
HMO-POS members will be
responsible for the same copays in- or
out-of-network when they visit a PCP or specialist, and
a modest amount more for other out-of-network benefits.
Will
Highmark reimburse members for payments made to UPMC?
Highmark
will pay for covered services rendered subject to a member’s
benefit. We will reimburse members for the eligible costs
after their copay is applied.
Will UPMC
physicians/facilities treat Security Blue or Freedom Blue
members (could also apply to Community Blue PPO)?
- No UPMC physicians have terminated
any contracts with Highmark.
- In an emergency, a Highmark Medicare
Advantage member can be treated in any hospital --
regardless of network status -- and will pay the same
copays in- or out-of-network.
- Highmark Freedom Blue PPO and
Security Blue HMO-POS plans offer
out-of-network benefits so members can continue to visit
those facilities on an out-of-network basis.
Where can I direct my
clients to receive additional information?
Member
Services is always available at 866-871-7710. Alternately,
Members can visit a Highmark Direct retail store to get
answers about their coverage. For more information
regarding our hospitals in Western PA, click here.
We will
continue to communicate any pertinent network
updates. Any questions should be directed to HighmarkSeniorMarkets@Highmark.com.
|
