Highmark has a long history of offering a broad range of products for our Medicare members including both in-network and out-of-network benefits and remains committed to providing convenient, affordable access to local health care providers and while traveling. They realize network changes on their Medicare products may create an increase in questions from your clients. To assist you, below are a few important reminders for frequently asked questions.
- Highmark has expanded out-of-network benefits for Freedom Blue PPO and Security Blue HMO-POS Medicare Advantage plans to make it easier for members to access care.
- There is no change for Highmark’s Community Blue Medicare HMO and PPO or Medigap Blue members.
- Highmark is hosting more than 90 educational member events across the region; members can sign up for a meeting on our Digital Reservation Site, reservations.highmark.com.
Can UPMC require members to pay the full amount before they schedule?
It is true that Medicare-accepting providers are allowed to request payment before seeing a patient, but across the nation, providers have historically billed us directly for Medicare Advantage out of network care.
On October 2, UPMC declared they will require payment in full and in advance from Highmark Security Blue and Freedom Blue members for services scheduled with them after June 30, 2019 when using services on an out-of-network (OON) basis. We are reaching out to UPMC to clarify the details surrounding their recent announcement.
As an important reminder:
- Freedom Blue PPO members will be responsible for the same copay in- or out-of-network care for medical services including PCPs, specialists, OP surgery, IP admission, etc.
- Security Blue HMO-POS members will be responsible for the same copays in- or out-of-network when they visit a PCP or specialist, and a modest amount more for other out-of-network benefits.
Will Highmark reimburse members for payments made to UPMC?
Highmark will pay for covered services rendered subject to a member’s benefit. We will reimburse members for the eligible costs after their copay is applied.
Will UPMC physicians/facilities treat Security Blue or Freedom Blue members (could also apply to Community Blue PPO)?
- No UPMC physicians have terminated any contracts with Highmark.
- In an emergency, a Highmark Medicare Advantage member can be treated in any hospital — regardless of network status — and will pay the same copays in- or out-of-network.
- Highmark Freedom Blue PPO and Security Blue HMO-POS plans offer out-of-network benefits so members can continue to visit those facilities on an out-of-network basis.
Where can I direct my clients to receive additional information?
Member Services is always available at 866-871-7710. Alternately, Members can visit a Highmark Direct retail store to get answers about their coverage. For more information regarding our hospitals in Western PA, click here.
We will continue to communicate any pertinent network updates. Any questions should be directed to HighmarkSeniorMarkets@Highmark.com.
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