Member Resources

You have rights and responsibilities as an Upper Peninsula Health Plan member.  UPHP Staff and affiliated providers will comply with all requirements concerning your rights. We will not discriminate against you for using your rights.

You have the right to:

  • Receive information about UPHP, its services, its practitioners and providers and member rights and responsibilities.
  • Be treated with respect and recognition of your dignity and right to privacy.
  • Participate in making decisions about your health care, including the right to refuse treatment and express preferences about treatment options.
  • Candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • Receive information on available treatment options and alternatives, presented in a manner appropriate with your condition and ability to understand.
  • Voice complaints or appeals about UPHP or the care we provide.
  • Make recommendations regarding UPHP’s member rights and responsibilities policy.
  • Receive Culturally and Linguistically Appropriate Services (CLAS).
  • Confidentiality.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Request and receive a copy of your medical records, and request they 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.
  • 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 provided.
    • the structure and operations of UPHP.

You are responsible to:

  • Supply information (to the extent possible) that UPHP and its practitioners and providers need in order to provide care.
  • Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
  • Follow plans and instructions for care that you have agreed to with your practitioners.
  • Contribute towards your health by taking responsibility, including appropriate and inappropriate behavior.

If you have questions about your rights and responsibilities, or need an interpreter, UPHP is here to help. Please call UPHP Customer Service at 1-800-835-2556 (TTY: 711), Monday through Friday from 8 a.m. to 5 p.m. Eastern Time.

Do you need help finding resources? If yes, UPHP has a program to help you! Connected Communities for Health (CC4H) is a help desk and online directory that connects you with social service programs in your area. It can help with needs such as food, clothing, childcare, transportation, housing, utilities, employment, education, and more. Visit. www.uphp.com/cc4h to find resources in your area.

If you’d like to speak with someone instead, call (906) 225-5964 to get connected to our dedicated team of community health workers. They will help ensure your needs are met and offer any extra assistance you need.

UPHP is required to provide you with electronic access to your health information. Learn more

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.

About the Lifeline Program

The Lifeline Program provides monthly aid to reduce or get rid of the cost of phone and internet for approved households. Below are companies who can help with the costs.

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.
  • Hospitals.
  • 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.

 

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
  • Medications

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)
Fax: 906-225-9269

Or

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)

MDHHS Office of Inspector General Online Complaint Form

Your report may be anonymous.


Page Last Updated: 09/7/2021