Questions about Health Insurance

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

Christopher A. Gessner, President, Children's Hospital of Pittsburgh of UPMCFor more than 125 years, UPMC Children's Hospital of Pittsburgh 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.

With the consent decrees between UPMC and Highmark ending on June 30, 2019, some patients and families may have questions about their commercial health insurance coverage. 

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 and beyond.

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
UPMC Children's Hospital of Pittsburgh

Frequently Asked Questions

Q:  If I am a parent with Highmark commercial health insurance and cannot go to certain UPMC hospitals after June 30, 2019, can I still bring my kids to Children’s Community Pediatrics and UPMC Children's Hospital of Pittsburgh?

A: Yes. Children’s Hospital and Children’s Community Pediatrics are currently in-network providers for all Highmark health insurance products, and will remain in-network after June 30, 2019.

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 services on the Children's campus in Lawrenceville are 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 local Children's Community Pediatrics office?

A: Yes. All of the Children’s Community Pediatrics office 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 2019. Will the surgery be covered?

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

Q:  Do Children’s and its physicians participate with all of the Medicaid Health Maintenance Organizations (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 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 even if I have a Highmark insurance product?

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. (Children's offers other adult programs too.)

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 he turns 18?

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 and beyond. Children’s doctors work with patients and their 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 a Highmark commercial health insurance product, will I be able to bring my child to a Children’s Express Care Center after June 30, 2019?

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 a Highmark insurance product 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 a Children's location?

A: Yes, that service is provided by the UPMC Sports Medicine Concussion program in partnership with Children’s at Pine Center located in Wexford and Children's South located in South Fayette.

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 in Wexford).

Q:  I have Highmark commercial health 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 June 30, 2019.

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

Q: I know that the Consent Decrees between UPMC and Highmark end on June 30, 2019. Does this affect whether or not I can continue to access Children's Hospital locations and physicians?

A: No. Access to UPMC Children's Hospital of Pittsburgh, including physicians and providers, Children's Community Pediatrics, and neighborhood locations of Children's Hospital, is not affected by the end of the Consent Decrees and will remain in-network for all Highmark insurance products after June 30, 2019.