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.
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. 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.
This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. This website 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.
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