Logan Reid
As of July 1, 2019, UPMC Mercy Hospital in Pittsburgh, Pennsylvania, is no longer in-network with Highmark insurance. This means that Highmark-insured Medicare Advantage members cannot use their insurance at UPMC Mercy Hospital as easily as they could previously. However, UPMC does accept most major insurers, including Highmark members with broad-network commercial or Medicare Advantage plans, who have full, in-network access to UPMC hospitals.
| Characteristics | Values |
|---|---|
| UPMC Mercy Hospital accepts Highmark insurance | Yes, but with limited access for members with narrow-network commercial plans and narrow-network Medicare Advantage plans |
| UPMC hospitals that do not accept Highmark insurance | UPMC Magee-Womens Hospital (Pittsburgh), UPMC East (Monroeville, Pa.), UPMC Hamot (Erie, Pa.), UPMC McKeesport (Pa.), UPMC Montefiore (Pittsburgh), UPMC Passavant (Cranberry Township, Pa., and Pittsburgh), UPMC Presbyterian (Pittsburgh), UPMC St. Margaret (Pittsburgh), UPMC Shadyside and its UPMC Hillman Cancer Center (Pittsburgh) |
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What You'll Learn
- UPMC accepts most major insurers
- Highmark members with broad-network commercial or Medicare Advantage plans have full access
- Highmark members with narrow networks have limited access
- UPMC Mercy Hospital (Pittsburgh) is out-of-network for Highmark
- UPMC facilities in Western Pennsylvania are mostly out-of-network for Highmark
UPMC accepts most major insurers
As of 2019, UPMC Mercy Hospital in Pittsburgh was set to leave Highmark's provider network, meaning Highmark-insured Medicare Advantage members would no longer be able to access most UPMC facilities in Western Pennsylvania as in-network.
However, UPMC does accept most major insurers, including Aetna, Cigna, Highmark, United Healthcare, and UPMC Health Plan. Highmark members with broad-network commercial or Medicare Advantage plans (which is the majority of Highmark members) have full, in-network access to UPMC hospitals, doctors, and services. This means that patients with these plans can access UPMC hospitals, doctors, and services as if they were in-network without incurring additional out-of-network costs.
On the other hand, Highmark members with narrow-network commercial plans and narrow-network Medicare Advantage have limited in-network access to UPMC facilities. These members should carefully review their plans with Highmark to understand the specifics of their coverage within the UPMC network.
It is important to note that insurance acceptance can change over time, and it is always advisable to contact the hospital directly or review your insurance plan for the most up-to-date and accurate information regarding coverage and accepted insurers.
Additionally, in rural areas where UPMC is the dominant hospital provider, some exceptions may apply, allowing Highmark members to access specific UPMC facilities as in-network even if they are outside of their network.
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Highmark members with broad-network commercial or Medicare Advantage plans have full access
As of 2019, UPMC Mercy Hospital in Pittsburgh was set to leave Highmark's provider network. This means that Highmark-insured Medicare Advantage members would no longer be able to access most UPMC facilities in Western Pennsylvania as in-network. However, it is important to note that Highmark members with broad-network commercial or Medicare Advantage plans (which represent the majority of Highmark members) have full, in-network access to UPMC hospitals, doctors, and services.
This means that Highmark members with broad-network plans can continue to seek medical care at UPMC Mercy Hospital and other UPMC facilities without worrying about limited access or higher out-of-network costs. This full access to UPMC's network includes hospitals, doctors, and various medical services. This is in contrast to Highmark members with narrow-network commercial plans and narrow-network Medicare Advantage plans, who have more restricted access to UPMC's network.
For Highmark members, the benefit of having broad-network plans is the assurance of comprehensive coverage across a wide range of healthcare providers. This includes not only UPMC Mercy Hospital but also other UPMC facilities, providing a diverse range of medical services. By having full access to UPMC's network, Highmark members can choose from a larger pool of healthcare professionals and facilities, increasing their options for specialized care and potentially reducing wait times for appointments and treatments.
Additionally, having full access to UPMC hospitals through their broad-network plans gives Highmark members the flexibility to seek care at the most convenient and preferred location for their specific needs. This can be especially important for individuals with unique medical requirements or those seeking specialized treatments. With UPMC's commitment to serving the healthcare needs of communities in western Pennsylvania and beyond, Highmark members can take advantage of UPMC's extensive network and choose the hospital or doctor that best suits their individual circumstances.
It is important for Highmark members to carefully review their plan details to understand the extent of their in-network access to UPMC facilities. While broad-network plans offer comprehensive coverage, there may still be specific exceptions or limitations outlined in their plan. By reviewing their plan details, Highmark members can make informed decisions about their healthcare choices and ensure they maximize the benefits provided by their insurance carrier. This proactive approach empowers individuals to take control of their healthcare journey and make the most of the resources available to them through their insurance plan.
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Highmark members with narrow networks have limited access
While UPMC accepts most major insurers, including Highmark, the type of Highmark plan a member has will determine their access to UPMC hospitals, doctors, and services. Highmark members with broad-network commercial or Medicare Advantage plans have full, in-network access to UPMC. However, Highmark members with narrow-network commercial plans and narrow-network Medicare Advantage plans have limited in-network access to UPMC.
Highmark members with narrow networks should carefully review their plan to understand their access to UPMC services. They may have more limited options for hospitals, doctors, and providers within the UPMC network. It is important to note that UPMC encourages members with questions about their insurance coverage to call their help line for more information.
Highmark, as an insurer, offers a range of networks to its members, including broad and narrow networks. These networks determine the providers and facilities that members can access for their healthcare needs. Highmark's networks are designed to provide timely updates and perks for members, and they ensure equal access and non-discrimination for all members. Highmark also offers Community Blue Medicare HMO and PPO networks, which are select, high-value networks in specific counties.
The Community Blue Medicare PPO network, for example, is limited to certain counties and provides exclusive access to particular facilities and doctors. To be included in Highmark's networks, providers must meet specific criteria and maintain high-quality standards. Highmark also monitors practitioner availability annually to improve member access to covered services. This includes assessing primary care practitioners, high-volume specialty care practitioners, and all behavioural health practitioner types.
In summary, Highmark members with narrow networks may have more limited access to UPMC hospitals, doctors, and services compared to those with broad-network plans. It is important for members to understand their specific plan details to make informed decisions about their healthcare and to be aware of the networks and providers available to them through their Highmark insurance plan.
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UPMC Mercy Hospital (Pittsburgh) is out-of-network for Highmark
As of July 1, 2019, UPMC Mercy Hospital in Pittsburgh is out-of-network for Highmark insurance members. This means that Highmark-insured patients will no longer be able to visit UPMC Mercy Hospital as in-network, and may face higher out-of-pocket costs for services received at this hospital.
UPMC Mercy Hospital is one of ten UPMC hospitals that left Highmark's provider network in 2019, including UPMC Magee-Womens Hospital, UPMC East, UPMC Hamot, UPMC McKeesport, UPMC Montefiore, UPMC Passavant, UPMC Presbyterian, UPMC St. Margaret, and UPMC Shadyside/Hillman Cancer Center.
This change primarily affects Highmark-insured Medicare Advantage members, who will no longer have in-network access to most UPMC facilities in Western Pennsylvania. However, there are a few exceptions to this change, including rural areas where UPMC is the dominant hospital provider.
It is important to note that UPMC does accept most major insurers, including Aetna, Cigna, Highmark, United Healthcare, and UPMC Health Plan. Highmark members with broad-network commercial or Medicare Advantage plans still have full, in-network access to UPMC hospitals, doctors, and services. However, members with narrow-network plans may have limited access to UPMC facilities.
If you are a Highmark insurance member considering treatment at UPMC Mercy Hospital in Pittsburgh, it is important to carefully review your insurance plan and contact Highmark for more information about your specific coverage and network options.
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UPMC facilities in Western Pennsylvania are mostly out-of-network for Highmark
As of July 1, 2019, UPMC facilities in Western Pennsylvania are mostly out-of-network for Highmark, impacting thousands of elderly residents in the region. This means that Highmark-insured Medicare Advantage members will not be able to access most UPMC hospitals, doctors, and services as in-network providers.
The following UPMC hospitals were set to leave Highmark's provider network by July 1, 2019:
- UPMC Magee-Womens Hospital (Pittsburgh)
- UPMC East (Monroeville, Pa.)
- UPMC Hamot (Erie, Pa.)
- UPMC McKeesport (Pa.)
- UPMC Mercy (Pittsburgh)
- UPMC Montefiore (Pittsburgh)
- UPMC Passavant (Cranberry Township, Pa., and Pittsburgh)
- UPMC Presbyterian (Pittsburgh)
- UPMC St. Margaret (Pittsburgh)
- UPMC Shadyside and its UPMC Hillman Cancer Center (Pittsburgh)
However, it is important to note that Highmark members with broad-network commercial or Medicare Advantage plans still have full, in-network access to UPMC hospitals, doctors, and services. Additionally, in rural areas where UPMC is the dominant hospital provider, Highmark patients may still have access to some UPMC facilities in-network.
To understand their specific plan benefits and limitations, Highmark members are encouraged to carefully review their plan details.
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Frequently asked questions
As of July 1, 2019, UPMC Mercy Hospital is no longer in-network with Highmark insurance.
Being out-of-network means that Highmark-insured patients will have to pay higher fees for treatment at UPMC Mercy Hospital.
The decision was made by UPMC and affected 10 hospitals in total, including UPMC Mercy.
Yes, Highmark members with broad-network commercial or Medicare Advantage plans still have full, in-network access to UPMC hospitals. Additionally, in rural areas where UPMC is the dominant hospital provider, Highmark patients can still access UPMC hospitals in-network.
