Questions about Health Insurance

A Message From Christopher Gessner, President, Children's Hospital of Pittsburgh of UPMC

For 125 years, Children’s Hospital of Pittsburgh of UPMC has provided high-quality health care to all of the region’s infants, children, teenagers, and young adults regardless of their health insurance coverage or ability to pay.

Recently, some families have told us they have received confusing phone calls and letters from insurance companies, including Highmark, implying that they will not be able to bring their children to Children’s to receive health care after December 31, 2014, or after they turn 18 years of age.

That is simply not true, and we would like to set the record straight.

  • Children’s Hospital and all of our physicians are considered in-network providers for every health insurance carrier that operates in this region, including Highmark.
  • Our agreements with the health insurance carriers cover all of our services from primary care visits (including Children’s Community Pediatrics) to hospitalization, and everything in between.
  • We continue to provide care for many of our patients well into their 20s.

If you have questions or concerns about whether you can bring your child to Children’s for care, please call us at 412-692-7600 from 8 a.m. to 4 p.m., Monday through Friday, so we can help.

Thank you for making Children’s Hospital and Children’s Community Pediatrics part of your family’s comprehensive health care team.

Christopher Gessner
President
Children's Hospital of Pittsburgh of UPMC


Frequently Asked Questions

Q:  If I am a parent with Highmark insurance and cannot go to certain UPMC hospitals after Dec. 31, 2014, can I still bring my kids to Children’s Community Pediatrics and Children’s Hospital of Pittsburgh of UPMC?

A: Yes. Children’s Hospital and Children’s Community Pediatrics are in-network providers for all Highmark health insurance products.

Q:  Are all the services on Children’s campus in Lawrenceville, including imaging, lab, and therapy, considered in-network for all health insurance companies?

A: Yes. All of our services are covered in-network for all health insurance products available in western Pennsylvania.

Q:  If I live in Uniontown, PA can I still take my kids to the Children’s Community Pediatrics office in our town?

A: Yes. All 38 of the Children’s Community Pediatrics offices locations are included in all health insurance plans available in western Pennsylvania.

Q:  Can I still take my kids to the Children’s Specialty Care Center in Erie if I have Community Blue health insurance?

A: Yes. All of Children’s services and locations are considered in-network for all Highmark products, including Community Blue.

Q:  We have Highmark insurance and my child is scheduled to have ear tubes put in at the Children’s North Surgery Center in 2015. Will the surgery be covered?

A: Yes. All of the services that Children’s and its physicians provide at all of its locations are considered in-network for all Highmark products.

Q:  Do Children’s and its physicians participate with all of the Medicaid HMOs in Western Pennsylvania?

A: Yes. Children’s Hospital, Children’s Community Pediatrics, and all of its physician specialists are considered in-network providers for all of the Medicaid HMOs.

Q:  I have Aetna Insurance and my husband’s new company offers United Healthcare. Does Children’s participate in those health plans?

A: Yes. Children’s and all of its physicians and services are considered in-network providers for all health care insurance plans available in western Pennsylvania, including Aetna, Cigna, Health America/Coventry, United Healthcare, and UPMC Health Plan.

Q:  I am a 47-year-old with congenital heart disease. I have been a patient at Children’s since I was born. Am I still able to be cared for at Children’s when I turn 50?

A: Yes. Children’s has a special program – the Adult Congenital Heart Disease program – that cares for adult patients who were born with heart disease throughout their lifetime.

Q:  My son has irritable bowel disease (IBD). He turns 18 next month and has always been cared for by Children’s Hospital gastroenterologists. Can I still bring him to Children’s after his 18th birthday?

A: Yes. There is no strict cutoff age for our patients. Many of our patients have had their conditions and diseases since childhood, and we may care for them well into their 20s. Children’s doctors work with patients and the families to help them transition to an adult physician when the time is right. This time may be different for each young adult and family.

Q:  If Children’s and its physicians are considered in-network providers, do I still need to pay my deductible, co-insurance, and/or copay?

A: Yes. Depending on your plan’s level of coverage, you are still responsible for those out-of-pocket costs.

Q: If I am a parent with Highmark insurance, will I be able to bring my child to a Children’s Express Care Center after Dec. 31?

A: Yes. All of the services provided by Children’s and its physicians are considered in-network for all Highmark insurance products.

Q: If I have Highmark insurance and my newborn needs intensive care, can my baby still come to Children’s?

A: Yes. All of the subspecialty services provided by Children’s, including Newborn Medicine, continue to be in-network.

Q: If my child has a concussion, can he or she still receive treatment at Children’s Hospital?

A: Yes, that service is provided at the UPMC Sports Medicine Concussion program offered in partnership with Children’s at Children’s at Pine Center, which is located in Wexford.

Q: My child sees a pediatric ophthalmologist and optometrist. Are those services still considered in-network if I have Highmark insurance?

A:  Yes, you can still receive those services, including purchasing eye glasses, at the UPMC Eye Center at Children’s (which has locations in Lawrenceville and at Pine Center).

Q:  I have Highmark insurance and my son’s pediatric neurologist is employed by University of Pittsburgh Physicians (UPP), which is part of UPMC. Will my son’s visits with this pediatric specialist still be covered after Dec. 31, 2014.

A:  Yes. All of the pediatric specialists in UPP are part of Children’s Hospital and therefore considered in-network for all Highmark products.