General Frequently Asked Questions

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General Frequently Asked Questions

Are there any impacts to prescription drug coverage?

If you utilize Highmark’s pharmacy services: Many plans do allow 90-day fills for certain medications; however, others may limit to a 30- or 34-day supply. Members interested in receiving a 90-day supply of medication should check their benefits and then have a conversation with their primary care physician to determine if this is appropriate. Medication quantity limits may also apply. If you do not utilize Highmark’s pharmacy services please contact your pharmacy benefit manager. 

Is Highmark reaching out to inform and engage members with chronic conditions who may be at a greater risk?

Yes, we have initiated an outbound call process for commercial members without email addresses on file. We are providing them with important information on the Coronavirus, or COVID-19. We are in the process of classifying members into different risk groups by age and known pre-existing conditions, but are not yet using this assessment to prioritize our calls. These calls will apply to Medicare Advantage members as well. 

How is Highmark informing members about important health and safety issues during the Coronavirus crisis?

We are providing important information, updates, and safety tips in both active and passive ways. Actively, we have produced a “Know Where to Go” email and direct mail campaign to keep members aware of the best ways to safely find medical care in these extreme circumstances. We have also issued an “Assurance” email and letter that explain what we are doing to keep our members and our community safe and aware. Additionally, we have created a highly informative site that we are continually updating with the latest Coronavirus information—www.HighmarkAnswers.com. We have also assembled timely and relevant information for our commercial clients at www.HighmarkEmployer.com

Is Highmark making specific recommendations for telehealth, nurse lines, or digital pathways to medical care and diagnosis?

We are waiving all fees for most telemedicine services until June 13, 2020—including behavioral health sessions for those suffering from anxiety during the crisis. Telemedicine is a great way to avoid leaving home when sick and still receive medical assistance. Members should call the number for Member Service on the back of their Highmark card to find which telemedicine service is in network. The Member Service number is plan-specific and is the fastest path to correct answers about their coverage. 

Is Highmark providing special recommendations for medical care?

If members think they are sick or have symptoms of COVID-19, we are recommending several paths to medical assistance. Contact their primary care physician, who can determine whether or not the member needs a test and can prescribe one. Or schedule a telemedicine appointment—the easiest way to avoid leaving home when ill and still receive medical assistance. Members should call the number for Member Service on the back of their Highmark card to find which telemedicine service is in network. Or in case of a medical emergency—difficulty breathing or another emergency medical need—call 911. If planning to visit an emergency room, members are encouraged to call ahead and let the facility know they are coming so it can prepare for their arrival and avoid exposure to others. 

Does Highmark have site of care plans for members who are unable to access care because of hospital or physician shortages?

Highmark provides several telemedicine options to members. Members should call the number for Member Service on the back of their Highmark card to find which telemedicine service is in network. This is the easiest and safest way for members to receive medical assistance and avoid leaving home. Additionally, many primary care physicians’ offices offer telemedicine options. Members should contact those directly. We are waiving all fees for most telemedicine services for the next 90 days—this includes behavioral health sessions for those suffering from anxiety during the crisis. 

Are current wellness and disease management programs adding special outreach for members with chronic conditions?

All of our member-facing clinical services staff have access to the latest COVID-19 guidelines from the CDC (Centers for Disease Control and Prevention) and the WHO (World Health Organization). We have initiated an outbound call process for commercial members without email addresses on file. We are providing them with important information and safety tips from a cross functional team in clinical services that includes nurses, a pharmacist, and customer service advocates with physician oversight. Additionally, our nursing team now has the ability to message in a two-way conversation with members via a secure mobile platform. 

Are you enhancing behavioral health programs for caregivers and other members?

Highmark behavioral health specialists and licensed social workers are available to provide direct counseling and care access assistance.