Highmark response to UPMC Out-of-Network (OON) Pre-payment Policy 

THE ISSUE

• On October 1, UPMC Health System confirmed that they will treat any Highmark Freedom Blue PPO or Security Blue HMO-POS MA member who wishes to receive care at an OON UPMC facility after 6/30/19. We are pleased that UPMC has followed the example of other hospitals across the country, which accept out-of-network benefits.
• However, UPMC is requiring these members to pay in-full the estimated cost of any procedure in advance of  even scheduling the procedure, and then reconcile with Highmark afterwards on cost sharing as outlined in their plans. 
• This is an unprecedented move for any Medicare provider. We have been unable to identify any other example – across the country – of a provider demanding payment from Medicare Advantage patients in advance of scheduling services.

HIGHMARK’S RESPONSE

• While this decision by UPMC is disheartening, it is not entirely surprising to see them put financial interests ahead of patient care. However, Highmark is committed to addressing this most recent imposed barrier to care for our members.
• Highmark has always strived to advocate for our members and to provide them with affordable access to high-quality care, along with the tools, support, and resources to embrace their health. And that will not change.
• Highmark also has an extensive provider network of high-quality physicians and hospitals that are happy to treat members without requiring them to pay before they receive service. Our My Care Navigator team is standing by at (888) 258-3428 to help members find a high-quality provider, who will treat them without a pre-payment required.
• But for our Freedom Blue PPO or Security Blue HMO-POS members who seek out-of-network care from a UPMC provider, rest assured that Highmark is exploring every option possible – legal, regulatory, legislative and more – to ensure these members are protected. After all, that is why so many members for so many years have come to count on blue.
• Highmark will continue to provide additional updates throughout the AEP season to ensure you have all of the information you need.
• In the meantime, you can also remain confident that Highmark’s Freedom Blue PPO and Security Blue HMO-POS members can access EITHER in or out of network care with the award winning service they’ve come to expect from Highmark.

If you have questions, please contact our Broker Services Team at highmarkseniormarkets@highmark.com or call (800) 652-9459.