You have rights and responsibilities as an Upper Peninsula Health Plan (UPHP) member. Our staff and affiliated providers will respect your rights. We will not discriminate against you for using your rights.
You have the right to:
- Receive information on beneficiary and plan information.
- Be treated with respect and with due consideration for your dignity and privacy.
- Get help with any special language or cultural needs you may have.
- Have your health and personal information stay confidential.
- Participate in decisions regarding your health care, including the right to refuse treatment and express preferences about treatment options.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Know the names and backgrounds of your health care provider.
- Request and receive a copy of your or your minor dependents’ medical records, and request those to be amended or corrected.
- Get high-quality health care services consistent with our Medicaid contract and state and federal regulations.
- Be free to exercise your rights without adversely affecting the way UPHP, providers, or the state treats you.
- Be free from other discrimination prohibited by state and federal regulations.
- Receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand.
- Have UPHP staff and its providers comply with all of your rights and responsibilities.
- Direct access to network women’s health specialists and pediatric providers for covered services necessary to provide routine and preventive health care services without a referral.
- Receive Federally Qualified Health Center (FQHC) and Rural Health Center (RHC) services.
- Request information about:
- Physician incentive arrangements,
including those that cover referral
services that place the physician at
significant financial risk (more than 25%),
other types of incentive arrangements,
and whether stop-loss coverage is
- The structure and operations of UPHP.
- Our services.
- Our practitioners and providers.
- Member rights and responsibilities.
- Physician incentive arrangements,
- Have full discussions with your provider about your health status, medical care, or treatment options, including any alternative treatment that may be self-administered, regardless of cost or benefit coverage.
- Get any information you need to decide among all relevant treatment options,
including the risks, benefits, and consequences of treatment or non-treatment.
- Participate in decisions regarding your health care, including the right to refuse treatment, and to express preferences about future treatment decisions.
- Voice complaints, grievances, or appeals about UPHP and its services, benefits, providers, and care.
- Get your questions answered about your bills.
- Have medical benefits even if you have or had a long-term illness or problems before you enrolled in UPHP.
- Know what UPHP expects of you.
- Make suggestions about member rights and responsibilities policy.
You have the responsibility to:
- Contribute to your health by behaving in an appropriate manner to your providers, all health care staff, other patients, and UPHP staff. Take responsibility for your inappropriate behavior.
- Tell your doctors your full health and social history.
- Follow the advice of your doctors.
- Get care if you are pregnant.
- Call UPHP Customer Service as soon as you know that you are pregnant.
- Ask questions about your care.
- Make and keep appointments.
- Cancel your appointments 24 hours ahead of time if you cannot go.
- Follow UPHP rules.
- Tell your local Department of Health and Human Services (DHHS) office about name, address, and telephone number changes.
- Always carry your current mihealth and UPHP ID cards.
- Call UPHP if your UPHP ID card is lost or stolen.
- Call the Beneficiary HelpLine if your mihealth ID card is lost or stolen.
- Tell UPHP, your local DHHS office, the Beneficiary HelpLine (1-800-642-3195), and your doctors if you have other insurance.
- Work with your primary care provider (PCP) to manage your health.
- Understand your health problems so that you and your doctors can set treatment goals.
- Work with UPHP Clinical Services staff to help manage an ongoing health problem.
- Provide information needed by UPHP or your doctors.
- If you have more than one doctor, ask them to communicate about your care.
Do you need help finding resources? If yes, UPHP has a program to help you! The Connected Communities for Health (CC4H) help desk will help you find things like:
The CC4H help desk has committed community health workers that can help find the resources you need. They will also follow up with you to ensure your needs are met and offer any extra assistance. If you need help, please call (906)-225-5964 to enroll in this free program.
UPHP has a nurse advice line available to our members. If you are unable to reach your PCP’s office, the nurse advice line:
- Is available to UPHP members 24 hours a day by telephone.
- Can help you to decide if your symptoms need immediate attention in the Emergency Department or if you can wait to be seen by your PCP.
- Can provide you information about your medications, self-care, or
other health information prior to getting in to see your PCP.
You should try to contact your PCP’s office before contacting the nurse advice line. Your PCP knows you and your conditions best. The nurse advice line is not able to help you with questions about benefits or services. Please contact UPHP Customer Service at 1-800-835-2556 (TTY: 711) for questions about benefits and services.
The UPHP Medicaid Nurse Advice Line toll-free phone number is 1-877-615-2915.
The UPHP Quality Assessment and Improvement and Utilization Management (QAI/UM) Program is an ongoing process that takes place throughout the year that addresses:
- The quality and safety of clinical care.
- The quality of service.
- The members’ experience with their providers and the health plan.
Each year UPHP evaluates:
- Member access to care.
- Provider performance against national standards.
- Member/provider surveys, complaints, and grievances.
- Service utilization processes.
Two tools used to measure the plan’s performance include:
- Consumer Assessment of Healthcare Provider and Systems (CAHPS)
- A survey that asks individuals and families about the health care they are receiving.
- UPHP receives feedback as to whether members are happy with their care and their doctors.
- Healthcare Effectiveness Data and Information Set (HEDIS)
- Measures performance of care and services using clinical guidelines.
- Allows UPHP to compare the plan’s performance against other health plans.
- Measured annually.
For additional information on the QAI/UM Program or to receive a copy of the most recent QAI/UM Summary Report ,call UPHP Customer Service at 1-800-835-2556 (TTY: 711).
You can also review the MDHHS Medicaid Quality Check Up.
The online provider directory gives you a complete list of UPHP providers and services, including:
- PCPs and specialists.
- Durable medical equipment providers.
- Maternal Infant Health Program (MIHP) providers.
- Family-planning services.
- Health departments.
- Eye care (exams and glasses).
NOTICE OF PRIVACY PRACTICES: Effective October 1, 2016
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Upper Peninsula Health Plan (UPHP) is required by law to protect the privacy of your protected health information (PHI). We are also required to:
- Provide you with notice of our legal duties regarding your PHI.
- Provide you with notice of our privacy practices regarding your PHI.
- Comply with the terms of the notice that is currently in effect.
- Notify individuals who are affected by a breach of unsecured PHI.
UPHP has the right to use and give out your PHI for:
- Treatment: We may give out medical facts about you to coordinate your health care. For example, we may tell your personal doctor about the care you got in an emergency room.
- Payment: We may use and give out medical facts about you so that the medical services you get can be billed and paid for. For example, we may ask a hospital emergency room for details about your care before we pay for it.
- Business Operations: We may need to use and give out medical facts about you in regard to our business operations. For example, we may use medical facts about you to review the quality of services you get.
UPHP may share information about you with your family, close friends or others involved in payment for your care, or share information about you in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, UPHP may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious imminent threat to health or safely.
UPHP is allowed or required to share your PHI in other ways-usually in ways that contribute to the public good, such as public health and research. UPHP may share your PHI for the following reasons:
- To comply with the law: UPHP will share information if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
- To help with public health activities: UPHP may share information in certain situations, including preventing disease.
- To report suspected abuse, neglect or domestic violence: UPHP may share information about suspected abuse to the appropriate agency.
- For government health care oversight activities: UPHP may share information for activities such as audits and investigations.
- To respond to lawsuits and legal actions: UPHP may share health information about you in response to a court or administrative order; or in response to a subpoena.
- To do research: UPHP may use or share your information for health research.
- For organ and tissue donation and transplant reports: UPHP may share information with organ procurement organizations.
- In emergency situations: UPHP may share information to prevent or reduce a serious threat to anyone’s health or safety.
- To address workers’ compensation, law enforcement and other government request: UPHP may share information for workers compensation claims, law enforcement purposes or with a law enforcement official, and other government functions such as military and national security.
UPHP may never share your PHI for the following reasons, unless you give us written permission to do so:
- Marketing purposes.
- Sale of your information.
- Most uses and disclosures of psychotherapy notes.
If any state or federal privacy law requires us to provide you with more privacy protections, we are obligated to comply with that law in addition the requirements outlined in this notice.
Copies of This Notice
You have the right to get a copy of this notice at any time. Even if you agree to get it
electronically, you still have a right to a paper copy of it. Please call or write to us to ask for a copy.
Changes to This Notice
We reserve the right to change the terms of this notice. The changes will apply to all information we have about you. The new notice will be available upon request and on our web site.
You Have the Following Rights Regarding your PHI
Your Right to Inspect and Copy
You or your personal representative may request access to the PHI in your designated record set. The UPHP Privacy Officer must receive the request for access in writing. The requested information will be provided within 30 days of the request. A single 30 day extension is allowed if UPHP is unable to comply with the deadline. UPHP may charge a cost-based fee. We can deny your request, but we must give a written reason for our denial.
Your Right to Request Restrictions
You may ask UPHP to limit what we use or share. You may ask us not to use or share certain health information for treatment, payment, or operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. We are not required to agree to your request, unless the request is to restrict disclosure of your PHI to a health plan and the PHI pertains solely to a health care item or service for which you have already paid the medical provider in full. You or your personal representative must submit the request in writing and must include:
- What information you want to limit.
- Whether you want to limit our use, disclosure or both.
- To whom you want the limits to apply.
Your Right to Amend
If you feel that the facts we have about you are wrong or incomplete, you can make a written request to us to fix it. Requests for an amendment to PHI in a designated record set should be made to the UPHP Privacy Officer. We may deny your request if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer able to make the amendment.
- Is not part of the health information kept by or for the Plan.
- Is not part of the information which you would be permitted to inspect and copy.
- Is accurate and complete.
We must give you a written reason for our denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures or your PHI.
Your Right to a List of Disclosures
You have a right to get a list of our disclosures of your facts, except when the disclosure was to you, you approved the disclosure, or if the disclosure was made for treatment, payment, or health care operations. We are not required to give you a list of disclosures made before April 14, 2003. You must submit your request in writing to the UPHP Privacy Officer. Your request must state a time period which may not be longer than six years. UPHP will provide one list within a 12-month period for free, but will charge a cost-based fee for additional lists requested within 12 months.
Your Right to a Notice of a Breach
You have the right to receive notification if your protected health information is breached. We will notify you of the breach as soon as possible, but no later than sixty (60) days after the breach has been discovered.
Your Right to Ask for Confidential Communications
You have the right to ask that we discuss your medical matters with you in a certain way or at a certain place. Your request must be in writing. For example, you can ask that we only contact you at home, at a certain address, or by mail. We will accommodate all reasonable requests.
Other Uses of Protected Health Information
Other uses and disclosures of your protected health information not covered by this Notice or allowed by law will only be made with your written permission. If you provide permission to use or disclose protected health information, you may revoke that permission, in writing, at any time. If you revoke your permission, UPHP will no longer use or disclose protected health information about you for the reasons covered by your written authorization. UPHP is unable to take back any disclosures we already made with your permission.
How to Use Your Rights in This Notice
If you want to use your rights in this notice, you may call or write to us. If your request to us must be in writing, we can help you to write it, if you wish.
Complaints and Communications to Us
If you want to exercise your rights under this notice, wish to tell us about privacy issues, or wish to file a privacy-related complaint, you can write to:
Chief Privacy Officer
Upper Peninsula Health Plan
853 West Washington Street
Marquette, MI 49855
You may also call us at 1-800-835-2556. You will not be penalized if you file a complaint.
Complaints to the Federal Government
If you think that your privacy rights have been violated, you have the right to file a complaint with the federal government. You will not be penalized if you file a complaint. You may contact:
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
NOTICE FOR FINANCIAL INFORMATION: Effective October 1, 2016
THIS NOTICE DESCRIBES HOW FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED.
UPHP protects your “personal financial information”. Personal financial information (FI) means information about an enrollee or an applicant obtained to provide coverage. FI identifies an individual and is not generally publicly available.
Information we collect
Depending on the product you are enrolled in, UPHP may get FI about you from:
Applications or other forms, this may be name, address, age and social security number. Your transactions with us or others; this may be premium payment data.
Disclosure of Information
We do not share personal financial information about our enrollees or former enrollees, except as required or permitted by law. For example, we may share FI to companies for business purposes, such as to process your transactions.
Confidentiality and Security
UPHP maintains physical, electronic and procedural safeguards in accordance with applicable state and federal standards to protect your information. Computer safeguards, secured files and buildings are in place to protect your information.
Questions about this Notice
You have a right to the privacy of your information. If you have any questions or need help understanding our privacy practices, call UPHP Customer Service at 1-800-835-2556. To submit a written request, mail to:
Upper Peninsula Health Plan
853 West Washington Street
Marquette, MI 49855
If you think your privacy rights have been violated, you may send a complaint to the address above. You may also notify the U.S. Department of Health and Human Services. If you have any questions about compliance, call UPHP Customer Service at the number listed above.
If you are new to UPHP, we want to ensure that you have continued access to care that you were getting prior to joining UPHP. This care could include:
- Out-of-network providers
- Durable medical equipment/medical supplies
UPHP has a care team to help you and assist you with your health care needs. To request continued care, you, your authorized representative, or your treating provider can contact UPHP by writing or calling:
Upper Peninsula Health Plan
Attn: Utilization Management
853 West Washington St.
Marquette, MI 49855
Toll-Free Phone: 1-800-835-2556 (TTY: 711)
Contact your UPHP Care Coordinator
When contacting UPHP, the more detail you can give, the better UPHP will be able to help you. Examples of information we may need include:
- Provider name(s)
- Phone number(s)
- Appointment date(s) (if applicable)
Our UPHP care team will review your care needs and enter in any needed authorizations.
Review the UPHP Transition of Care Policy for more information.
Fraud is when you knowingly deceive someone else. It can also be when you misrepresent yourself. This then results in some benefit to you or some other person that is not allowed. Some types of fraud may include:
- A doctor billing UPHP for services that you did not get.
- Someone else using your mihealth or UPHP card.
- Changing a prescription.
- Giving false facts about you or someone else.
- Not telling providers you have other insurance.
Abuse is any action that results in unneeded costs to UPHP. Either a provider or a member can take this action. Some types of abuse are:
- Going to the emergency room if there is no emergency.
- Threatening or abuse behavior (by phone, in writing, or in person).
You may report possible fraud and abuse to:
UPHP Customer Service
853 West Washington Street
Marquette, MI 49855
Call toll-free at 1-800-835-2556
Michigan Department of Health and Human Services Office of Inspector General
P.O. Box 30062
Lansing, MI 48909
Call toll-free at 1-855-MI-FRAUD (643-7283)
Your report may be anonymous.
Page Last Updated: 04/13/2021