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Information and Frequently Asked Questions for Patients With Out-of-Network Products

UPMC is committed to providing patients with the information they need to make informed decisions about their care. While many health insurers provide their members with full, in-network access to UPMC, there are certain types of health insurance plans and other products, including those that use unilateral repricing, that do not. Unilateral repricing plans are out-of-network with UPMC hospitals and facilities.

When UPMC refers to a unilateral repricing plan — sometimes called a “reference-based pricing” plan — it means a plan that, as a general rule, chooses not to contract with hospitals or health care facilities. Rather, these plans decide unilaterally how much to pay out-of-network hospitals or facilities for a patient’s care. When these plans pay the hospital, facility, or doctor less than the amount owing for that care, they put the patient in the middle of a billing dispute. These plans force health care providers to recover any unpaid amounts (beyond copays, coinsurance, or deductibles) directly from the patient.

UPMC requires payment in advance from patients who wish to schedule out-of-network care.


Companies UPMC has Identified as Excluding UPMC Hospitals and Facilities From Some or All Products They Sell or Promote:

  • 6 Degrees Health
  • Advanced Medical Pricing Solutions (AMPS)
  • Aither Health
  • Alliance Coal
  • Allied Benefit Systems
  • Apostrophe
  • Auxiant
  • Azeros Health Plan
  • BAS Benefits
  • Benefit Administrative Systems
  • Cornerstone Preferred Resources
  • Custom Design Benefits
  • EBMS Employers
  • EBSO
  • ELAP
  • Enterprise Group Planning
  • Entrust
  • Fox Everett
  • Flume Health
  • Group & Pension ADMIN
  • Health Scope
  • Healthnow
  • HealthPlans, Inc.
  • HMN – HMA
  • Homestead Smart Health Plans
  • HST
  • INDECS
  • INDECS Corporatin
  • INDECS Wirerope
  • Independent Health
  • Insurance Benefit ADMIN
  • Insurance Benefit Administration
  • JP Farley
  • Lifeshield
  • Loomis Company
  • Lucent Health
  • Maestro Health
  • MCA Administrators
  • Oscar Health Insurance
  • Performance Health
  • SISCO
  • Star Marketing
  • Trustmark
  • Tufts Health Plan
  • Wellnet Healthcare Admin

Please Note: If a plan is not listed, that does not mean that it is in-network. The best way for a member to check provider network status is to ask their plan.

Frequently Asked Questions


Contact Us

If you have questions about access to any UPMC doctors, hospitals, or services, please call our help line at 1-855-646-8762.

Updated 10/14/2020