Alyssa Lane
Highmark is a health and wellness organization that offers health insurance plans to individuals and businesses in PA, DE, WV, NENY, and WNY. It is one of the largest health insurers in the United States. Highmark operates under the Blue Cross Blue Shield (BCBS) Association, with plans known as Highmark Blue Cross Blue Shield or Highmark BCBSD. These plans are available in various regions, including Western and Northeastern PA, Central and Southeastern PA, Delaware, West Virginia, Western NY, and Northeastern NY. Highmark also provides Medicaid insurance in New York. The organization has a history dating back to the 1930s, and its predecessor companies were established to help Pennsylvania residents pay for healthcare during the Great Depression.
| Characteristics | Values |
|---|---|
| Company Name | Highmark Inc. |
| Type | Health and Wellness Organization |
| Location | Pittsburgh |
| Area Served | PA, DE, WV, NENY, WNY |
| History | Predecessor companies established during the Great Depression to help Pennsylvania residents pay for healthcare |
| Blue Cross and Blue Shield Movement | Hospital association in Pittsburgh sponsored formation of Blue Cross of Western Pennsylvania (now Highmark BCBS); Pennsylvania Medical Society backed founding of Pennsylvania Blue Shield (now Highmark Blue Shield) |
| Consolidation | Two Blue plans consolidated in 1996 to form Highmark Inc. |
| Product Offerings | Health insurance plans for individuals and businesses, including Medicare Advantage, Medicaid, Individual and Small Group Affordable Care Act, Large Group Fully Insured, Large Group Self-Insured |
| Diversified Businesses | Dental insurance and other related businesses |
| Member Benefits | My Highmark app for plan benefits, health insurance coverage answers, and insurance terms and definitions |
Explore related products
What You'll Learn
Highmark Blue Cross Blue Shield
The company also has a presence in neighbouring states, such as Delaware, West Virginia, and New York. In Delaware, Highmark operates as Highmark BCBSD Inc., while in West Virginia, it does business as Highmark Blue Cross Blue Shield, Highmark Health Insurance Company, or Highmark Senior Solutions Company. In Western and Northeastern New York, Highmark Western and Northeastern New York Inc. offers plans under the name Highmark Blue Cross Blue Shield.
Highmark provides a user-friendly app called My Highmark, which serves as a one-stop platform for plan beneficiaries to manage their healthcare. The app allows users to access information about their health insurance coverage, learn about health plans, and get answers to questions regarding insurance terms and definitions. Highmark is committed to ensuring compliance with applicable laws and government program requirements, including fraud prevention and detection.
Term Insurance: Waste of Money or Smart Move?
You may want to see also
Explore related products
Highmark Health Insurance Company
Highmark is a health and wellness organization located in Pittsburgh, offering health insurance plans in PA, DE, WV, NENY, and WNY. Highmark Inc. is the company that provides health benefits or health benefit administration to its members and is affiliated with Blue Cross Blue Shield (BCBS).
Highmark Blue Cross Blue Shield (BCBS) is a Medicare Advantage HMO, PPO, and/or Part D plan with a Medicare contract. Enrollment in these plans depends on contract renewal.
For Highmark Health Insurance Company plans not purchased on the Health Insurance Marketplace, members can call 1-866-697-4080 to request a copy of their plan. The My Highmark app is also available for members to easily manage their healthcare and access their plan benefits.
Highmark members can refer to the member guide and website for more information on taking charge of their healthcare and understanding their health plan benefits.
Navigating the Path to Becoming an Insurance Adjuster in Oklahoma
You may want to see also
Explore related products
Highmark's fraud prevention program
Highmark is a BCBS health and wellness organisation that offers health insurance plans in PA, DE, WV, NENY and WNY. The company has a robust fraud prevention program, which includes partnerships with federal law enforcement agencies, such as the FBI, and the deployment of AI and other advanced analytical tools to combat fraud, waste and abuse.
Highmark's Financial Investigations and Provider Review (FIPR) department is central to its fraud prevention efforts. FIPR works to prevent schemes that increase costs and endanger customers' health. It ensures appropriate provider reimbursements and investigates suspected insurance fraud, waste or abuse. FIPR combines innovative technology with the expertise of a multidisciplinary team to protect customers.
Highmark's anti-fraud initiatives have saved over $2 billion since 2017, with most savings coming from correcting billing errors. The Designated Pharmacy Program, launched in 2014, has successfully reduced fraud, abuse and unnecessary prescriptions. As of 2024, the program reported a 30.6% reduction in urgent care and ER visits, a 21.1% reduction in controlled substance prescriptions, and a 757,584-unit decrease in dispensed medication.
Highmark also focuses on senior fraud prevention, aiming to educate members about financial scams targeting older adults. In 2023, those over 60 lost over $3.4 billion to scams, averaging $33,915 per person. Common scams include impersonators pretending to be from a bank, credit card company, employer, or law enforcement, creating a sense of urgency to obtain personal and financial information. Highmark partnered with the FBI in 2024 to raise awareness of elder fraud, using multimedia resources, in-person education and community outreach to reach 650,000 seniors.
Uber Drivers: Commercial Insurance Requirements and You
You may want to see also
Explore related products
Highmark's history
Highmark is a national, diversified healthcare partner that serves members across the U.S. through health insurance, dental insurance, and reinsurance. It is a large for-profit health insurer in the United States, operating several for-profit subsidiaries.
Highmark was created in 1977 and in 1996, through the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association: Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield. The consolidation, approved by the Pennsylvania Insurance Department on November 27, 1996, resulted in a new company—Highmark Inc. Highmark began operations on December 6, 1996, conducting business in Western Pennsylvania as Highmark Blue Cross Blue Shield and in the rest of Pennsylvania as Pennsylvania Blue Shield, partnering with three Blue Cross plans to provide complete coverage.
Highmark expanded its operations in 1999 when it formed a partnership with Mountain State Blue Cross Blue Shield, becoming the primary licensee of the Blue Cross and Blue Shield service marks in West Virginia. In 2010, Blue Cross Blue Shield of Delaware signed an affiliation agreement with Highmark, and in 2011, the agreement was approved, with the company becoming Highmark Blue Cross Blue Shield Delaware (Highmark Delaware). In June 2015, Highmark secured final approval from the Pennsylvania Insurance Department to merge with Blue Cross of Northeastern Pennsylvania (BCNEPA), becoming Highmark Blue Cross Blue Shield and providing health insurance coverage and administrative services to nearly 550,000 individuals in BCNEPA's 13-county service area.
Highmark has continued to grow and diversify its operations through various joint ventures and partnerships. In 2011, Highmark announced its purchase of the financially troubled West Penn Allegheny Health System (WPAHS), expanding its presence in the healthcare industry. In 2021, Highmark acquired HealthNow, which operated BlueCross BlueShield in Western and Northeastern New York, and entered a collaboration with League to create Living Health's integrated platform and digital health solutions. Highmark has also formed partnerships with other Blue plans to create Synergie Medication Collective, improving access to affordable medications, and Evio, a pharmacy solutions company.
Fire Insurance: Who's Responsible, Landlord or Commercial Tenant?
You may want to see also
Explore related products
Highmark Blue Shield
In West Virginia, Highmark operates as Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, and in Western and Northeastern New York, it operates as Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Highmark also offers Medicaid insurance in New York and is committed to ensuring compliance with the federal Deficit Reduction Act of 2005.
Highmark's entry into Southeastern Pennsylvania in 2024 was a significant milestone, making it the only statewide Blues plan. This expansion added over 75,000 members in two years, totalling 190,000 lives covered through their diversified lines of business. Highmark Blue Shield offers a range of products, including Medicare Advantage, Medicaid dual-eligible, and various Affordable Care Act plans.
WellCare: Commercial Insurance or Not?
You may want to see also
Frequently asked questions
Commercial insurance is insurance for businesses, also known as business insurance.
BCBS stands for Blue Cross Blue Shield, an association of independent licensees that provide health insurance plans.
Highmark is a health and wellness organization that offers BCBS health insurance plans in PA, DE, WV, NENY, and WNY.
Highmark was formed in 1996 through the consolidation of Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield, both of which were founded in the 1930s to help residents pay for healthcare.
You can contact Highmark by calling 1-888-544-6679 for plans purchased on the Health Insurance Marketplace or 1-866-697-4080 for plans not purchased on the Health Insurance Marketplace.
