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.