Patient Advocates for Highmark Blue Cross Blue Shield - Find one today.
Supporting and empowering Highmark Blue Cross Blue Shield patients in Western and Northeastern Pennsylvania.
Highmark Blue Cross Blue Shield serves Western and Northeastern Pennsylvania with comprehensive coverage options, but navigating their complex authorization requirements and multi-tiered appeal process can be overwhelming and time-consuming. Your Solace advocate understands Highmark's policies inside and out—from securing prior authorizations to appealing denied claims and helping you access specialists across Pennsylvania's diverse geography. They'll handle the paperwork, follow-ups, and endless phone calls so you can focus on your health instead of fighting insurance bureaucracy.
Best of all, most patients pay nothing out of pocket.
.avif)
About
Highmark Inc., doing business as Highmark Blue Cross Blue Shield in Western and Northeastern Pennsylvania, is part of Highmark Health, a large health insurance organization headquartered in Pittsburgh. Highmark offers a range of coverage options including individual and family plans, employer group plans, Medicare Advantage, and Children's Health Insurance Program (CHIP) coverage in Pennsylvania. As a division of Health Care Service Corporation, Highmark provides access to an extensive provider network, but members often face challenges with their strict documentation requirements for prior authorizations and a complex appeal process governed by Pennsylvania's Act 68 and Act 146 regulations. Highmark's claim processing system operates under a 365-day timely filing requirement, with electronic claims typically processing in 7-14 calendar days compared to 21-27 days for paper claims, creating additional hurdles for members seeking resolution for denied claims or authorizations.
What problems can a Highmark Blue Cross Blue Shield patient advocate help you with?
%20(1).avif){kind=small}
Get the clarity you need to make sense of your care and take charge of your health.
We’ll make the calls (and the callbacks) so you can spend more time doing what you love.
Keep your care affordable with lower medical bills and access to local financial help.
Advocates review coverage, handle preauthorizations, and even help with appeals.
Stay on top of the cutting-edge treatment options and leave no stone unturned.
Advocates coordinate your care team so your health never falls through the cracks.
Get the tools and answers you need to make informed decisions about your care.
Advocates help you overcome your healthcare hurdles—no matter how big they might be.
Solace has helped over 14,000 patients and families
Rose G.
04/01/2024
Eric H.
08/07/2024
Joan H.
05/01/2024
Stephen I.
04/27/2024
Jonathan J.
06/05/2024
Anne J.
07/27/2024
Highmark Blue Cross Blue Shield Appeals with a Patient Advocate
Highmark's appeal process is governed by Pennsylvania's Act 68 and Act 146 regulations, involving multiple stages that can be challenging to navigate alone. For standard appeals, your Solace advocate knows how to prepare comprehensive appeals that include all necessary documentation to address Highmark's specific requirements. They'll track deadlines, follow up persistently, and guide you through each stage of the process, from initial review to external review with the Pennsylvania Insurance Department if necessary.
When facing a Highmark denial, your advocate will immediately identify whether the issue stems from missing documentation, coding errors, network limitations, or medical necessity determinations. They'll work with your healthcare providers to gather supporting evidence and may coordinate peer-to-peer reviews between your doctor and Highmark's medical directors. For specialty care needs, they can help you navigate Highmark's tiered network structure to access appropriate providers at the most cost-effective level. If your claim was denied due to timely filing issues, they understand the documentation needed to prove the claim was submitted within Highmark's 365-day requirement, ensuring you aren't improperly billed for covered services.
Pennsylvania's complex healthcare regulations and Highmark's multi-layered policies create a labyrinth that only a knowledgeable Solace advocate can efficiently navigate.
The Solace care team model
With Solace, you get both a patient advocate and a supporting physician, which we refer to as your “care team”.
Your advocate will be there to manage the day to day aspects of your care: coordinating with doctors, researching potential solutions and communicating updates to you.
Your supporting physician can unlock resources for you and your advocate that might otherwise be out of reach.
We’ve Got Answers
Still unsure how an advocate can help? Explore these answers to the questions we’re asked the most.
How are Solace advocates qualified to help?
Advocates on Solace are experienced physicians, nurses, pharmacists, and other healthcare professionals from a wide range of backgrounds. 98% of Solace patients report better healthcare outcomes after working with an advocate.
What else can a Solace advocate help me with?
What can a Solace advocate not do?
We know our advocates sound like miracle workers, but they have limits. They can’t prescribe medications or diagnose an illness, for instance. They can’t replace your doctor, but they can break down the barriers standing between you and the quality care you deserve.