Information and Frequently Asked Questions for
Patients With Out-of-Network Products
UPMC is committed to providing patients with the information they need to make informed decisions about their care. While many health insurers provide their members with full, in-network access to UPMC, there are certain types of health insurance plans and other products, including those that use unilateral repricing, that do not. Unilateral repricing plans are out-of-network with UPMC hospitals and facilities.
When UPMC refers to a unilateral repricing plan - sometimes called a "reference-based pricing" plan - it means a plan that, as a general rule, chooses not to contract with hospitals or health care facilities. Rather, these plans decide unilaterally how much to pay out-of-network hospitals or facilities for a patient's care. When these plans pay the hospital, facility, or doctor less than the amount owing for that care, they put the patient in the middle of a billing dispute. These plans force health care providers to recover any unpaid amounts (beyond copays, coinsurance, or deductibles) directly from the patient. UPMC requires payment in advance from patients who wish to schedule out-of-network care.
Click here to see frequently asked questions and answers regarding this issue. If you have any additional questions, please contact your UPMC Health Plan account manager. |
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