Important information regarding UPMC access for Highmark
Medicare Advantage members

In July, the Pennsylvania Supreme Court confirmed calendar year 2018 will be the last full year most UPMC hospitals and physicians in western Pennsylvania will be in-network for Highmark Medicare Advantage members.

Most UPMC hospitals and physicians in the greater Pittsburgh and Erie areas will be out-of-network for Highmark Freedom Blue and Security Blue Medicare Advantage members after June 30, 2019. Highmark Community Blue Medicare Advantage HMO/PPO members will be out-of-network for all of 2019. Although UPMC is under no obligation to schedule appointments for out-of-network patients, we recognize that patients who choose a product with no in-network access to UPMC might still want occasional care from us. To accommodate these patients, UPMC will continue providing services to them on an out-of-network basis as we have during the several years of the Consent Decrees.

Highmark Medicare Advantage members who use UPMC providers will be asked to pay out-of-pocket for their care before receiving some services. This means Highmark Medicare Advantage members may have higher costs up front when using UPMC providers. Services can include: chest X-ray’s, cataract surgery and EKG’s. Emergency care will not require advance payment.

UPMC Health Plan members, including those enrolled in one of our
UPMC for Life Medicare Advantage plans, will not be affected by this change and will not need to pay up front for services received at UPMC providers, other than the applicable copay. 

UPMC has begun the process of letting Medicare beneficiaries know about these changes. Various channels will be used to relay this message to the affected Highmark patients, UPMC Health Plan members, and the community. Please see the attached Frequently Asked Questions for more details. Those with insurance questions are encouraged to call the UPMC Help Line (1-855-946-8762) for more information and can also find this information online: UPMC.com/Choice2019.

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

For more information, please contact your UPMC Health Plan Sales Executive or Account Manager.