Highmark Will Keep Rothman Orthopaedics In-Network
Pittsburgh-based Highmark reached a contract deal with Rothman Orthopaedics to avoid coverage disruption on October 1.
Updated on Sept. 23, 2026 in Healthcare
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Highmark announced an agreement to maintain Rothman Orthopaedics as an in-network provider for its insurance plans starting October 1, 2026. This move resolves a dispute that threatened to cut off access for Pennsylvania policyholders.
Why it matters
The resolution avoids a major network gap for Pittsburgh-area patients who rely on the practice for specialized care. It follows a contentious summer negotiation regarding billing practices under the federal No Surprises Act.
The dispute involved approximately six surgeons out of the total provider network. The underlying contract governing these services originally took effect on January 1, 2025.
The players
Highmark
Headquartered in Pittsburgh, this large health insurance organization provides coverage to millions of residents across Pennsylvania and other states.
Rothman Orthopaedics
This private medical practice specializes in orthopedic services and maintains a significant provider presence across the region.
The details
Highmark previously issued a termination notice this summer after alleging contract violations tied to the federal No Surprises Act. The insurer accused surgeons of using out-of-network physician assistants to secure large arbitration payments, while Rothman maintained those staff members were employed by a separate, independent entity.
Timeline
January 1, 2025: The initial contract between the two parties took effect.
Summer 2026: Highmark issued a formal termination notice to Rothman Orthopaedics.
September 23, 2026: Both organizations announced the new agreement.
October 1, 2026: Coverage continues as the new agreement takes effect.
Market Landscape
This dispute highlights the ongoing friction between insurers and medical practices regarding the federal No Surprises Act. As providers and payers navigate these arbitration rules, legal and contract battles continue to influence network participation and patient access.
Patients with Highmark insurance in Pennsylvania will maintain in-network access to Rothman Orthopaedics doctors beginning October 1. This prevents potential out-of-pocket cost spikes that would have occurred if the contract had lapsed.
The takeaway
Patients should always confirm their provider's current network status with their insurer prior to booking elective procedures. Understanding the specific insurance plan details remains the best way for individuals to avoid unexpected medical billing issues.
Further reading
Learn more about the local industry at Pittsburgh Healthcare.
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