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Transitioning Your Care

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Blue Cross of Northeastern Pennsylvania is now Highmark Blue Cross Blue Shield. But, your 2015 coverage is still offered through Blue Cross of Northeastern Pennsylvania—with the same coverage, benefits and out-of-pocket costs until you renew for 2016. You know you can count on Blue Cross of Northeastern Pennsylvania for quality health care services when you’re sick or hurt. But did you know you can also count on us to help you transition your care in the following situations?

  • If you’re a Blue Cross of Northeastern Pennsylvania member and you reach a benefit limit
  • If you’re a new BlueCare® HMO, HMO Plus or CHIP member being treated by an out-of-network doctor
  • If your child is switching from a pediatrician to an adult care provider

Here’s the information you need to help you make smart decisions and get the care you and your family need to stay healthy.

If You’re a Blue Cross of Northeastern Pennsylvania Member and Reach a Benefit Limit...

Depending on your Policy, some services may have a benefit limit. A benefit limit means that your Policy only allows a certain number of visits or days of a service each benefit period.

If you’ve reached your benefit limit and need further care, there are other resources available. Below is a list of community resources that may be able to help you transition your care. You may also call our Care Management department at 1.800.346.6149 or (TTY) 1.877.720.7771, weekdays, between 8 a.m. and 8 p.m. ET, where a nurse can help you coordinate your care.

To check your Policy’s benefit limits, refer to the Outline of Coverage you received with your Member Handbook or logon to Self-Service at bcnepa.com. Or, you can call Customer Service weekdays, 8 a.m. to 5 p.m., at the number on the back of your ID card.

Local Community Resources

Pennsylvania Department of Health

Phone: 1.877.PA.HEALTH (1.877.724.3258)
Website: www.health.state.pa.us

The Pennsylvania Department of Health improves health care quality, access, continuity and accountability, while coordinating health resources throughout the Commonwealth. In addition, the Department supports outreach, education, prevention and treatment services across a variety of program areas. Information is available to Pennsylvania residents on a variety of health topics and diseases, including, but not limited to, asthma, cancer, sickle cell and women’s health.


Behavioral Health Services―Department of Public Welfare

Phone: 1.800.692.7462
Website: http://www.dhs.state.pa.us/dhsorganization/officeofmentalhealthandsubstanceabuseservices/

Provides services to help children, adolescents and adults to remain in their communities. This includes services for individuals with both mental health and substance abuse disorders. Provides services through community and hospital programs, including outpatient, partial, residential, short-term in-patient hospital care, and emergency crisis intervention services, counseling information, referral and case management services.


Help Line of Northeastern Pennsylvania

Phone: 1.888.829.1341 or 570.829.1341
Website: helpline-nepa.info/

The Help Line is an information and referral service and first response point for crisis calls in Bradford, Luzerne, Sullivan, Tioga and Wyoming Counties. In addition to handling crisis situations, Help Line is also an information and referral service. Help Line maintains an active data listing of over 400 local agencies, as well as over 16,000 additional regional, state and national resources.


Drug and Alcohol Program―Department of Health

Phone: 1.877.PA.HEALTH (1.877.724.3258)
Website: www.health.state.pa.us/addiction

Provides resources for prevention, intervention, rehabilitation and treatment of drug and alcohol abuse. Individuals can receive confidential referral to treatment or counseling programs. Treatment may be free for eligible individuals.


PA Link to Aging and Disability Resources

Phone: 1.866.286.3636
Website: adrc-tae.org/

Provides information about long-term care support and services for older adults and people with disabilities.


Intellectual Disabilities Customer Service Line―Department of Public Welfare

Phone: 1.888.565.9435
Website: http://www.dhs.state.pa.us/fordisabilityservices/intellectualdisabilitiesservices/

Provides services and support for people with intellectual disabilities, including supported employment, vocational training and day habilitation, home and vehicle adaptations, respite care and transportation.


Medical Assistance Transportation Program (MATP)―Department of Public Welfare

Phone: 1.800.679.4135
Website: matp.pa.gov/MATP

Provides transportation to medical services for Medical Assistance consumers who do not have other transportation available to them.


Other Resources

​If none of these resources apply to your specific needs, or if you are receiving care outside of the Blue Cross of Northeastern Pennsylvania service area, you may contact charitable health care organizations related to your condition for help. Or, ask your doctor to suggest community resources that may be able to help you get more care.

If You’re a New BlueCare HMO, HMO Plus or CHIP Member Being Treated By an Out-of-Network Doctor...

If you are a new BlueCare HMO, HMO Plus or CHIP member and your doctor is not in the First Priority Health® network, don’t worry. In some cases, you can continue your treatment plan for a period of time, and your care will be covered, as if the doctor was in-network. If you are:

  • In the middle of a treatment plan—you may continue an ongoing course of treatment with an out-of-network provider for a transitional period of up to 90 days
  • Pregnant, in the second or third trimester (3-month period) on the effective date of your coverage—you can continue care with an out-of-network doctor through the delivery and postpartum care related to your delivery

Your doctor must agree to continue your care, and he/she must also agree not to bill you for charges above what we agree to pay. Call Customer Service at the number on the back of your ID card to learn more. Or, to learn more about your plan’s network, select your health insurance plan on My Insurance Plan and click on Your Network Map.

If Your Child Is Moving from Pediatric to Adult Care...

As teens get older, they will need to transition from a pediatrician to an adult care provider. The transition to adult care usually begins around the ages of 14 to17 and continues until they reach adulthood.

This transition period provides opportunities and activities where adolescents take on an independent role in making decisions about their care while under the support and guidance of a parent and doctor. Transitioning to adult care is important for teens to learn how to promote health and disease prevention and to maximize lifelong functioning and well-being.

To find an in-network adult care provider, go to findadoctor.bcnepa.com. If you have questions about transitioning to an adult care provider, please call Customer Service at the number on the back of your ID card.