Important news about Highmark Blue Cross Blue Shield and UPMC

February 26, 2019

​Here's what you need to know about an agreement allowing Highmark Blue Cross Blue Shield members to obtain care from UPMC providers on an in-network basis through June 30, 2019.

​The Pennsylvania Attorney General recently filed legal action to extend an agreement allowing Highmark Blue Cross Blue Shield (BCBS) members to obtain care from all UPMC providers on an in-network basis beyond June 30, 2019. This action is the latest development in an ongoing dispute between Highmark BCBS and UPMC. 

You could be affected if you access your medical benefits through Highmark BCBS and use a UPMC provider in western Pennsylvania. While the situation may change based on the court's decision, here’s what you need to know now. 

Who is affected

You may be affected if you’re enrolled in the PPO, EPO, or HDHP medical options. Without further action by the court, the agreement between Highmark BCBS and UPMC will expire June 30, 2019, and most UPMC hospitals and doctors in Allegheny County, Pennsylvania, as well as UPMC Hamot in Erie, Pennsylvania, will be out of network for Highmark BCBS members as of July 1, 2019.* However, there are some exceptions. The following UPMC providers would remain in-network after June 30, 2019:

  • UPMC Children’s Hospital of Pittsburgh
  • UPMC Western Psychiatric Hospital
  • certain UPMC cancer centers
  • most UPMC doctors and hospitals outside of Allegheny and Erie counties

If you use UPMC providers that are out of network after June 30, you will pay more out of your pocket; in some cases significantly more, depending on the medical coverage option you’re enrolled in:

  • If you’re in the PPO, you will be responsible for higher out-of-network deductibles and copayments, and you may be balance billed for amounts that exceed what the plan allows.
  • If you’re in the EPO or HDHP, you will be responsible for the entire cost of care, as these options do not cover out-of-network providers.

In addition, out-of-network providers may require you to pay the full cost of care upfront.

*These changes in network status don’t affect you if you access your medical benefits through the Board's Aetna option. All UPMC providers remain in-network for Aetna members.

What you can do

To avoid surprise bills and higher out-of-pocket costs, be sure to check the network status of your provider before you receive care. You can find network providers by calling a dedicated Highmark BCBS service, My Care Navigator, at 866-263-2583 Monday through Friday from 8 a.m. to 8 p.m. ET.

Register for information session

The Board of Pensions will be hosting an information session at Pittsburgh Presbytery Center, Tuesday, April 9, from 10:30 a.m. to noon.

Medicare Supplement Plan members

The Medicare Supplement Plan offered through the Board of Pensions is not affected by the end of the agreement between Highmark BCBS and UPMC or legal actions related to it. The plan gives you access to all providers who accept Medicare, including UPMC facilities and doctors. As long as your providers accept Medicare, there is no impact to you.