Before you book an appointment with a doctor or specialist, be sure that the provider is in your plan network. Choosing in-network providers helps you avoid paying higher out-of-pocket costs or being denied coverage for the service.
To find out if a doctor or specialist is in network, go to your member website homepage and select the Find Care tab, then the Search Doctors link. From there, type in the name of the person you’d like to see to get the following information:
Name, address, and telephone numbers.
Specialty and board certification status.
Medical school attended and residency completion.
Annual Women’s Health and Cancer Rights Act (WHCRA) notification
WHCRA is a federal law that provides certain rights and protections to patients after a mastectomy. This law requires most health insurance plans that cover mastectomies to also cover (after any applicable deductible and coinsurance):
All stages of reconstruction and surgery of the breast on which the mastectomy was performed.
Surgery and reconstruction of the other breast to produce a symmetrical appearance.
Treatment of physical complications of a mastectomy, including lymphedema.
Plus, you’ll also find information on:
For details about the information we collect, use, and disclose, as well as how we maintain your privacy, select the Legal tab at the bottom of the Coverage page to review:
• The Notice of Privacy Practices.
• Member Rights and Responsibilities.
• Mental Health Parity.
• Our Quality and Member Satisfaction.
Our rewards policy
Highmark does not reward employees, doctors, health care providers, or anyone else for denying coverage.
Need more information?
Both you and your doctor have the right to know the criteria and guidelines we use to make decisions about what’s covered and what’s not.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies. This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. It also does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal. ®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit our website to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
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