Both Highmark and UPMC are enforcing the terms of the state initiated Consent Decrees, which means many UPMC Health System claims that used to be covered as ‘in-network’ for Highmark are being processed as ‘out-of-network’. It is more important than ever that participants with Highmark coverage ensure any care being considered from a UPMC Health System provider is covered under the Consent Decree before receiving care. If not, participants could be faced with significant out-of-pocket costs that are not covered under their health plan. More information on the Consent Decrees is contained in the link below.
To assist in evaluating the network that best meets participants’ needs, the link below provides a side-by-side listing of the 2019 in-network hospitals in Western Pennsylvania for both Highmark and UPMC Health Plan.
2019-in-network-hospital-compare
Both carriers also provide comprehensive in-network coverage for emergency rooms, urgent care (e.g., MedExpress), retail clinics (e.g., Walgreen’s and CVS), primary care physicians (PCP), and specialists.
