You are encouraged to use network providers for all your medical care. Network providers have agreed to accept contracted rates for their services, which results in savings for both you and the plan. And, you can receive services from any network provider without a referral from your primary care physician.
You can save on your out-of-pocket costs for care by using providers who participate in the plan’s network.
To find network providers, visit Highmark’s website:
Or, call the number on the back of your medical ID card.
Important: If you are enrolled in the EPO or HDHP, you must use network providers. If it’s not an emergency and you see an out-of-network provider when you have access to a network provider, you will be responsible for all costs.
If you’re enrolled in the PPO: Your coverage includes out-of-network benefits for covered services. However, you’ll pay more out of your pocket if you see an out-of-network provider when you have access to a network provider. Emergency services provided by an out-of-network provider are the only exception.
Out-of-network providers may require you to pay for services upfront and then file a claim for reimbursement. See Guide to Your Healthcare Benefits for more information or call your service provider at the number on the back of your medical ID card.
If you’re enrolled in the EPO or HDHP: These options do not cover care received from out-of-network providers except for emergency services. If you use an out-of-network provider when you have access to a network provider, you will be responsible for all costs incurred.