Jeffrey Wade
If you have UPMC insurance, you can access UPMC doctors and hospitals in your community, as well as other providers. UPMC offers four network options, allowing you to choose the one that best suits your needs. UPMC Health Plan members also have access to global emergency assistance services through Assist America. It is always recommended to check with your insurer and review your plan before scheduling an appointment. UPMC hospitals are widely recognized for their quality care, with UPMC physicians consistently featuring on the annual U.S. News & World Report Honor Roll of America's Best Hospitals.
| Characteristics | Values |
|---|---|
| UPMC Health Plan members have access to | Global emergency assistance services through Assist America |
| Assist America can be used when | Experiencing an emergency while traveling more than 100 miles from home or to another country for less than 90 days |
| UPMC Health Plan | Offers four network options so you can choose the network that works best for you |
| UPMC Health Plan | Offers benefits beyond network access and high-quality care |
| UPMC Health Plan | Offers $0 preventive care for many health services for adults and children |
| UPMC Health Plan | Offers virtual urgent care 24/7 |
| UPMC Health Plan | Offers the UPMC Health Plan app for easy access to your health insurance information |
| UPMC Health Plan | Offers a Health Care Concierge team to help you navigate your benefits |
| UPMC in Central Pa. | Accepts most major health insurances, including Aetna, Capital Blue Cross, Highmark, and UPMC Health Plan |
| UPMC in North Central, Pa. | Accepts most major insurance plans |
| UPMC AnywhereCare virtual visits | Are covered at 100% after you meet your deductible for UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan |
| UPMC-employed providers | Can be selected by members in Pennsylvania at the time of a virtual visit |
| Highmark members | Have full, in-network access to UPMC hospitals, doctors, and services |
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What You'll Learn
- UPMC Health Plan members have access to global emergency assistance services
- UPMC hospitals, doctors, and services are accessible in-network to Highmark members
- UPMC in Central Pa. accepts most major health insurance plans
- UPMC AnywhereCare virtual visits are covered at 100% after meeting your deductible
- UPMC offers four network options so you can choose the one that works best for you
UPMC Health Plan members have access to global emergency assistance services
If you have UPMC insurance, you can access all UPMC doctors and hospitals in your community, as well as other providers. UPMC Health Plan members with broad-network commercial or Medicare Advantage plans have full, in-network access to UPMC hospitals, doctors, and services.
UPMC Health Plan members also have access to global emergency assistance services through Assist America. These services can be used if you experience a medical emergency while travelling more than 100 miles from home, or even in another country, for less than 90 days. Assist America can connect you and your covered family members to doctors, hospitals, and pharmacies.
If you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan, UPMC AnywhereCare virtual visits will be covered at 100% after you meet your deductible. UPMC Health Plan also offers a virtual urgent care service that is covered at 100% by most plans.
If you are a UPMC for Life member enrolled in an HMO plan, you have in-network coverage when travelling to Arizona, Florida, Georgia, North Carolina, South Carolina, and Tennessee. You pay the same cost-sharing as you would at home when seeing providers in these states. The Travel Concierge Program can help locate a provider or pharmacy, schedule a medical appointment, and obtain prior authorization for your services.
For information about UPMC's insurance services, visit the UPMC Health Plan website. If you are a current user and need assistance, you can email MyUPMC at [email protected] or call the support line at 1-866-884-8579.
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UPMC hospitals, doctors, and services are accessible in-network to Highmark members
Highmark members with broad-network commercial or Medicare Advantage plans have full, in-network access to UPMC. This includes access to UPMC hospitals, doctors, and services, without paying more out of pocket compared to other hospitals or providers. However, Highmark members with narrow-network commercial plans and narrow-network Medicare Advantage plans have limited in-network access to UPMC.
The availability of UPMC facilities for Highmark insurance plan holders has been a topic of discussion and some uncertainty. While there was a truce between UPMC and Highmark in 2019, it did not guarantee that all patients with UPMC or Highmark insurance plans could access doctors and hospitals in both networks. The truce applied to patients of all ages and those on individual or employer-based "broad-based" plans, offering partial benefits to other networks.
It is important for Highmark members to carefully review their plans to understand their specific coverage and access to UPMC hospitals, doctors, and services. While UPMC accepts Highmark insurance, the level of in-network access may vary depending on the specific Highmark plan.
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UPMC in Central Pa. accepts most major health insurance plans
If you have UPMC insurance, you can use the UPMC Health Plan app to easily access your health insurance information. UPMC offers benefits beyond network access and high-quality care. UPMC Health Plan includes four network options so you can choose the network that works best for you. UPMC in Central Pa. accepts most major health insurance plans, including Aetna, Capital Blue Cross, Highmark, and UPMC Health Plan.
UPMC AnywhereCare virtual visits are covered at 100% after you meet your deductible if you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan. UPMC also offers $0 preventive care that covers many health services for adults and children at 100%.
UPMC's standard charge for a COVID-19 diagnostic lab test is $155. If you have insurance, most plans will waive cost-sharing for COVID-19 testing, so there should be no out-of-pocket costs for this test.
It is important to verify your insurance coverage in advance of your appointment. You may receive bills from providers not employed by UPMC in Central Pa.
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UPMC AnywhereCare virtual visits are covered at 100% after meeting your deductible
If you have UPMC insurance, you have full in-network access to UPMC hospitals, doctors, and services. You can choose a primary doctor to help you manage your health and catch problems before they become serious. UPMC Health Plan offers four network options so you can choose the network that works best for you.
UPMC AnywhereCare is a telehealth service that's included with UPMC VirtualCare. It offers virtual visits with a high-quality provider and is available to everyone, regardless of insurance. You can access video visits, counseling resources, health coaches, and more virtually with UPMC AnywhereCare.
If you are enrolled in the UPMC Advantage Silver HSA $4,000/$0, UPMC Advantage Gold HSA $2,500/10%, or UPMC Advantage Catastrophic $9,200/$0 plan, UPMC AnywhereCare virtual visits will be covered at 100% after you meet your deductible.
For nonmembers, the cost of a virtual visit is $59 to $67. However, video visits with UPMC AnywhereCare range from $0 to $67, with most members paying $0 to $15. Non-members outside of Pennsylvania will pay $67 per visit.
Please note that Talk Therapy or Psychiatry services through AnywhereCare are not covered services for UPMC Community HealthChoices participants, UPMC for You members, or UPMC for Kids members.
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UPMC offers four network options so you can choose the one that works best for you
UPMC's network options include world-renowned hospitals and many community hospitals in the areas you call home. The UPMC Premium Network, for example, includes hospitals and healthcare facilities in 35 counties, including Allegheny, Armstrong, Beaver, and Bedford. The UPMC Partner Network is available for residents of 14 counties, including Allegheny, Bedford, Blair, and Butler. The UPMC Select Network serves residents of six counties, including Allegheny, Beaver, and Butler, while the UPMC Standard Network is for residents of Crawford and Clearfield counties.
If you are enrolled in certain plans, such as the UPMC Advantage Silver HSA $4,000/$0 or the UPMC Advantage Gold HSA $2,500/10%, UPMC AnywhereCare virtual visits will be covered at 100% after you meet your deductible. UPMC Health Plan commercial members in Ohio can access care through the SuperMed PPO Network and use the Cigna Healthcare PPO Network when travelling outside the state. UPMC for Life offers low-cost, high-quality coverage, with HMO, HMO D-SNP, and PPO plans available.
Highmark members with broad-network commercial or Medicare Advantage plans have full, in-network access to UPMC hospitals, doctors, and services. Those with narrow-network commercial plans and narrow-network Medicare Advantage have limited in-network access. You can also purchase individual commercial insurance plans from the Health Insurance Marketplace if you are under 65.
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Frequently asked questions
UPMC Health Plan members have access to doctors, hospitals, urgent care centres, and other healthcare facilities. UPMC has hospitals in Western Pa, New York, Central Pa, North Central Pa, Southwest Pa, Northwest Pa, West Central Pa, and many other locations. If you are in Pennsylvania, you may select a UPMC-employed provider. If you are outside of Pennsylvania, you will receive care from a provider employed by the Amwell Medical Group (OCN).
If you experience an emergency while travelling more than 100 miles from home, UPMC Health Plan members can access global emergency assistance services through Assist America.
If you have insurance and your UPMC plan covers the treatment, most plans will waive cost-sharing so there should be no out-of-pocket costs to you. However, it is always best to check with your insurer prior to your appointment.
