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.

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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?

Decoding Paperwork

Get the clarity you need to make sense of your care and take charge of your health.

Making Appointments

We’ll make the calls (and the callbacks) so you can spend more time doing what you love.

Negotiating Medical Bills

Keep your care affordable with lower medical bills and access to local financial help.

Resolving Insurance Snags

Advocates review coverage, handle preauthorizations, and even help with appeals. 

Exploring New Treatments

Stay on top of the cutting-edge treatment options and leave no stone unturned. 

Coordinating Doctors

Advocates coordinate your care team so your health never falls through the cracks.

Empowering Patients

Get the tools and answers you need to make informed decisions about your care.

Much More!

Advocates help you overcome your healthcare hurdles—no matter how big they might be. 

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Solace has helped over 14,000 patients and families

"My Solace advocate was a godsend as I struggled to make sense of our healthcare system. He listened to my questions, gave me the answers I needed, and made sure I always knew my options.”
Rose G.

04/01/2024

"Having a healthcare advocate by my side made all the difference. She handled the insurance paperwork, coordinated my appointments, and walked me through everything I needed to know."
Eric H.

08/07/2024

"I was completely overwhelmed trying to navigate the healthcare system on my own, but my Solace advocate took the burden off my shoulders. He was my dedicated guide through it all."
Joan H.

05/01/2024

"My Solace advocate was important in helping my brother get the right care. She was an unrelenting advocate, cutting through red tape, and keeping us updated at every turn."
Stephen I.

04/27/2024

"Signing up for a Solace advocate was one of the best decisions I’ve ever made. He took the time to truly understand my needs and got me connected with the right providers and resources."
Jonathan J.

06/05/2024

"My Solace advocate was a true partner in my healthcare journey. She gave me the tools and support to become an empowered patient and make truly informed decisions about my care."
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.

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FREQUENTLY ASKED QUESTIONS

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.

You don’t have to do this alone.

Start receiving support from your advocate today.

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