UPMC/Highmark Agreement Questions

As you navigate the new health insurance landscape, make sure St. Clair is in your network.

Health insurance in our region is changing rapidly, from the Affordable Care Act to the scheduled end of the Highmark-UPMC agreement. Fortunately, St. Clair Hospital makes navigating these changes easier because St. Clair participates with every major insurer in almost every product.* That means St. Clair is an in-network provider for these insurers and products. And, if you choose a health insurance product (like a high deductible health plan) that requires you to share in the cost of paying for services, you’ll be pleased to know St. Clair is often the lowset cost provider. So, when you choose a health plan, make sure you have one of the nation’s 100 Top Hospitals*, close to home, in your network.

*St. Clair hospital does not participate in two new “ultra-narrow network” products: [1] the Community Blue Medicare HMO medicare Advantage product offered by Highmark; and [2] UPMC Advantage Select HMO/PPO/EPO products offered by UPMC Health Plan on the federal health insurance marketplace [www.healthcare.gov]. St. Clair Hospital will be out-of-network for patients who select either of these products.

In advance of annual health insurance enrollment deadlines, HouseCall answers key questions below:

Will St Clair Hospital patients be affected when the contract between Highmark and UPMC expires on December 31, 2014?

No. Hospital and physician services provided at St. Clair Hospital will not be affected by the expiration of the contract between Highmark and UPMC.

What about services provided at St. Clair’s Emergency Room, its Urgent Care Center, and its Outpatient Centers?

Again, nothing will change as a result of the expiration of the contract between Highmark and UPMC on December 31, 2014.

What about clinical services such as radiation oncology and medical oncology in which St. Clair partners with UPMC Cancer Centers? Will those services be affected?

No. St. Clair’s clinical service partnerships and joint ventures with UPMC will remain in-network.

What about other health insurrers? Is St. Clair in-network for them, as well?

Yes. With the exception of the two products listed below,* St. Clair is in-network for every major health insurer, including Highmark, UPMC Health Plan, Aetna, Cigna, Coventry Health America, and United Healthcare, as well as all major Medicare Advantage plans, and all major Medicaid managed care plans.

What types of services does St. Clair Hospital offer?

St. Clair Hospital and its medical staff provide a wide range of advanced clinical services, as well as women’s and children’s care. All of these services will remain in-network for every major health insurer in almost every product.*

Who should a patient contact with additional questions about health insurance coverage at St. Clair Hospital?

Please call the Customer Service line at 412.344.3408 to speak to a St. Clair representative.

If a patient wants to switch to a St Clair-affiliated physician. How can he or she find a physician?

please use our physician finder at www.stclair.org/physicians/directory, or call 412.942.6560.