Home | Provider Resources | About Us | Contact Us | Search

En Español

Frequently Asked Questions

Do I need a referral?

No referral is needed by your PCP, or from UPMC Health Plan Behavioral Health Services/UPMC for behavioral health services. However, we strongly encourage you to contact UPMC Health Plan Behavioral Health Services @ 1-888-251-0083 before receiving any behavioral health services.

UPMC Health Plan Behavioral Health Services has an experienced team of behavioral health staff who can help you find the right behavioral health provider. We will search for network providers who treat patients like you and who are in a convenient location. We can easily match you up with an experienced professional.

What is my behavioral health co-pay?

Behavioral Health financial questions can be answered by calling UPMC Health Plan Behavioral Health Services Customer Services at 1-888-251-0083 or TTY at 1-877-877-3580. Medical Health financial questions can be answered by calling UPMC Health Plan member services 1-888-876-2756 or TTY at 1-800-361-2629.

What is my behavioral health deductible?

Behavioral Health financial questions can be answered by calling UPMC Health Plan Behavioral Health Services Customer Services at 1-888-251-0083 or TTY at 1-877-877-3580. Medical Health financial questions can be answered by calling UPMC Health Plan member services 1-888-876-2756 or TTY at 1-800-361-2629.

Why can't I continue seeing my old provider who is out of network?

Depending on your plan you may have out of network benefits. The HMO and EPO plan requires you to choose an in network provider, the POS (point of service) plan allows you to go out of network by first fulfilling your deductible, then we will pay a percentage of the contracted rate with providers (providers can balance bill for the remaining portion), the Preferred Provider Organization and Out of Area plans allow you to go out of network at anytime.

How can I find out who is an in-network behavioral health provider?

Contact UPMC Health Plan Behavioral Health Services customer service, 1-888-251-0083 or TTY at 1-877-877-3580, and someone will assist you.

How can I get a provider Directory?

Contact member services at UPMC Health Plan at 1-888-876-2756 or TTY at 1-800-361-2629 or click here to log onto the UPMC HealthPlan website.

Is my EOB a bill?

No, it is a statement of services received and unless stated, this is an Explanation Of Benefits for your records.

What if I'm on vacation or living out of the area?

Only emergency services are covered with non-network providers when you are on vacation or living out of the local area if you have a HMO or EPO plan. If you have a POS or PPO plan, only emergency services are covered at the highest benefit level. All other non-emergent services are covered at your lower benefit level since you will be using an out of network (non-participating) provider.