The UPMC for Kids provider network gives your child easy access to care. You don't need a referral to see in-network providers. You can find information about our provider network by calling us at 1-800-650-8762 (TTY: 711) or visiting our Provider Directory.
AmeriHealth Caritas Pennsylvania
UPMC for You, affiliate of UPMC Health Plan, offers high-quality care to eligible Medical Assistance recipients in 40 counties in the Commonwealth of Pennsylvania. This care is achieved by combining the benefits of a managed care organization with all the services covered by Medical Assistance.
We cover exams, cleanings, and fillings for all UPMC for You members. Avesis manages UPMC for You Dental benefits. Members can call Dental Member Services at 1-888-257-0474 to get a dentist's name or to see what dental benefits they have.
UPMC for You can help provide you with medical, maternity, vision, and dental care as well as no-cost or low-cost prescription drugs when you get sick. We handle all that — and much more — so you can live your life with less worry.
UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal.
Travel with a PlanIf you are traveling outside UPMC Health Plan's service area and need nonemergency care, you can: Call Member Services at 1-844-881-4146. You can also call the phone number on the back of your member ID card. A Health Care Concierge can help you find an urgent care center or a participating provider.
There are five easy ways to pay your bill:
- Sign up for autopay. Paying your bill every month is easy with autopay.
- Pay online. You can make a one-time payment by logging in to MyHealth OnLine.
- Call the number on the back of your member ID card.
- Visit a UPMC Health Plan Connect Center.
- Send a check or money order.
To start, HMO stands for Health Maintenance Organization, and the coverage restricts patients to a particular group of physicians called a network. PPO is short for Preferred Provider Organization and allows patients to choose any physician they wish, either inside or outside of their network.
UPMC Health Plan members will continue to have access to all AHN primary care physicians and specialists. UPMC for You products have access to the majority of AHN facilities including West Penn Hospital, Forbes Hospital, Jefferson Hospital and St. Vincent Hospital.
Starting January 1, 2016, UPMC started offering acupuncture coverage for its commercial plans which include most PPO, HMO, and EPO plans. At this time, Medicare (UPMC for Life) and Medicaid (UPMC for You) plans are not covered. ?Life Balance Acupuncture is proud to be an In-Network provider with UPMC.
Heritage Valley Medical Group ConvenientCare Welcomes UPMC for You Patients. Heritage Valley ConvenientCare is pleased to announce that UPMC for You, the Medical Assistance (Medicaid) program of UPMC Health Plan, is now accepted at all six ConvenientCare walk-in clinic locations.
HMO Insurance PlansPPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.
Understanding In-Network Access to UPMCUPMC provides most Highmark members with full, in-network access to UPMC hospitals, doctors, and services and accepts most major insurers, including Aetna, Cigna, Highmark, United Healthcare, and UPMC Health Plan.
All UPMC Pinnacle locations accept most major health insurances, including Aetna, Capital Blue Cross, Highmark, and UPMC Health Plan.
On June 24th, 2019, the Pennsylvania Attorney General announced that he has brokered a relationship between Highmark and UPMC. The organizations agreed to a 10-year contract offering full in-network access to Highmark members in certain health products that include UPMC in Pittsburgh and Erie.
You can purchase individual health insurance through the Health Insurance Marketplace. These are plans that meet government requirements per the Affordable Care Act. Learn more about ACA insurance options in Pennsylvania. Call 1-844-253-4059.
The company has a great selection of plans, good member resources, and a great reputation all around. So as long as the logistics of location fall into place, Highmark is definitely in the running of quality health insurance companies.
The University of Pittsburgh Medical Center (UPMC) is a $21 billion integrated global nonprofit health enterprise that has 89,000 employees, 40 hospitals with more than 8,000 licensed beds, 700 clinical locations including outpatient sites and doctors' offices, a 3.7 million-member health insurance division, as well as
Your pharmacy plan gives you access to a broad network of retail pharmacies nationwide, including CVS, Rite Aid, Sam's Club, and Walmart; regional chain pharmacies such as Giant Eagle, GIANT, MARTIN'S, and Wegmans; plus hundreds of independent pharmacies.
Routine vision exams twice a year. $100 allowance toward eyeglasses (one frame and two lenses) or toward one pair of contact lenses and fitting per year* Glasses or contact lenses to treat cataracts or aphakia (medical condition) Specialist eye exam with referral from PCP.
Emergency transportation and related Emergency Services provided by a licensed ambulance service constitute an Emergency Service and will be covered at the in-network level whether the service is provided by a Participating or Non- Participating Provider.
For bariatric surgery, insurance companies usually require at least six to 12 consecutive months of documented diet history. Many also require nutrition and psychiatric consultations. UPMC's Presurgical Lifestyle Program meets these insurance requirements.
