Authorizations

Upper Peninsula Health Plan (UPHP) does require some services and items to be reviewed prior to you receiving those services or items. This is called prior authorization. This approval from UPHP may be required before you get a service, medical equipment, or fill a prescription in order to be paid for by UPHP. Work with your provider to see if an authorization has been given. UPHP provides information to UPHP network providers on what services require prior authorization. You may also call UPHP Customer Service at 1-800-835-2556 (TTY: 711) to make sure you have the authorization you need. UPHP does not require referrals.

Your health care services are to be directed by your primary care provider (PCP) or specialist. You must use UPHP in-network providers for your care when available. These are health care providers that have a contract with UPHP as a provider of care. Use of out-of-network providers will require prior authorization from UPHP unless stated otherwise. Your UPHP provider can send in a prior authorization request for you to receive out-of-network services and/or for the services listed below.

  • Out-of-network services, including:
    • Planned hospital admissions and surgeries
    • Providers
    • Facilities
    • Medical Suppliers
  • If you need more than 144 units of physical and occupational therapy or 36 visits of speech therapy per calendar year
  • Genetic testing
  • Breast reduction surgery
  • Panniculectomy surgery (removal of excess skin after weight loss)
  • Bariatric surgery (weight loss surgery)
  • Dental services in a hospital outpatient setting
  • If you need more than 18 chiropractic visits per calendar year
  • Durable medical equipment (DME)
    • Bi-PAP/CPAP
    • Continuous glucose monitors
    • Hospital beds (semi and total electric)
    • Negative pressure wound therapy (wound vacs)
    • Osteogenic bone stimulators
    • Pneumatic compression
    • Power wheelchairs and accessories
    • TENS unit
    • Ventilators
    • Wearable cardioverter-defibrillators
  • Certain Medications- please go to https://www.uphp.com/pharmacy/ for more information
  • Emergency medical services
  • Family planning services, including out-of-network services/providers
  • Maternity care, including out-of-network providers

UPHP does not issue prior authorizations for services you have already received.

You can call UPHP Clinical Services-Utilization Management Monday through Friday from 8 a.m. to 5 p.m. Eastern Time to ask about prior authorization. You can also leave a message if you are not able to call during those hours. The toll-free phone number is 1-800-835-2556 (TTY: 711). Language assistance is available. You can get this information for free in other languages.


Page Last Updated: 06/4/2020