Highmark – UPMC
Beginning January 1, 2016, Highmark and UPMC began a new
settlement agreement regarding continuation of care for Highmark members. This
agreement extends until June 30, 2019.
Under the agreement:
- A patient’s treating
physician will determine whether continuing course of treatment at UPMC is
necessary. If the physician is independent, they must have referred the patient
to UPMC for service;
- Continuation of care at
UPMC will be available for care reasonably related to the treatment. In-network
access does not include routine wellness or preventive care;
- Highmark members who received treatment at UPMC for a confirmed
pregnancy on or before December 31, 2015 may continue in-network access to UPMC
for maternity post-partum care related to that pregnancy;
- If a patient’s treating physician decides that the
treatment does not need to continue at UPMC, that visit will be treated as
in-network and the patient will transition to a new, in-network provider.
If you have questions as to how this agreement impacts you,
please contact our Bureau of Consumer Services at 1-877-881-6388 or submit your question online.