Bills

If you have paid for a bill that you think Upper Peninsula Health Plan (UPHP) MI Health Link (Medicare-Medicaid Plan) should pay some or all of, you can ask UPHP MI Health Link to pay you back. This is called reimbursement.

Below are examples of situations in which you may need to ask our plan to pay you back or to pay a bill you have received.  

You can receive emergency services from any provider, whether or not the provider is a part of our network. When you receive emergency or urgently needed care from a provider who is not part of our network, you are only responsible for paying your share of the cost, not for the entire cost. You should ask the provider to bill the plan for our share of the cost.

  • If you pay the entire amount yourself at the time you receive the care, you need to ask us to pay you back for our share of the cost. Send us the bill, along with documentation of any payments you have made.
  • To make sure you are giving us all the information we need to make a decision, you can fill out our UPHP Claim Reimbursement Form to make your request for payment.
  • At times you may get a bill from the provider asking for payment that you think you do not owe. Send us this bill, along with documentation of any payments you have already made.
    • If the provider is owed anything, we will pay the provider directly.
    • If you have already paid more than your share of the cost of the service, we will determine how much you owed and pay you back for our share of the cost.
Network providers should always bill the plan directly, and ask you only for your share of the cost. But sometimes they make mistakes, and ask you to pay more than your share.
  • Whenever you get a bill from a network provider that you think is more than you should pay, send us the bill. We will contact the provider directly and resolve the billing problem.
  • If you have already paid a bill to a network provider, but you feel that you paid too much, send us the bill along with documentation of any payment you have made. You should ask us to pay you back the difference between the amount you paid and the amount you owed under the plan.
  • To make sure you are giving us all the information we need to make a decision, you can fill out our UPHP Claim Reimbursement Form to make your request for payment.

Sometimes a person’s enrollment in the plan is retroactive. (Retroactive means that the first day of enrollment has already passed. The enrollment date may even have occurred last year.)

If you were retroactively enrolled in our plan and you paid out-of-pocket for any of your covered services or drugs after your enrollment date, you can ask us to pay you back for our share of the costs. You will need to submit paperwork for us to handle the reimbursement.

  • Please contact UPHP Customer Service for additional information about how to ask us to pay you back and deadlines for making your request.
If you go to an out-of-network pharmacy and try to use your membership card to fill a prescription, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. (We cover prescriptions filled at out-of-network pharmacies only in a few special situations.) Please refer to the UPHP MI Health Link Member Handbook to learn more. Save your receipt and send a copy to us when you ask us to pay you back for our share of the cost.

If you do not have your plan membership card with you, you can ask the pharmacy to call the plan or to look up your plan enrollment information. However, if the pharmacy cannot get the enrollment information they need right away, you may need to pay the full cost of the prescription yourself.

Save your receipt and send a copy to us when you ask us to pay you back for our share of the cost.

You may pay the full cost of the prescription because you find that the drug is not covered for some reason.

  • For example, the drug may not be on the plan’s formulary or it could have a requirement or restriction that you did not know about or do not think should apply to you. If you decide to get the drug immediately, you may need to pay the full cost for it.
  • Save your receipt and send a copy to us when you ask us to pay you back. In some situations, we may need to get more information from your doctor in order to pay you back for our share of the cost of the drug.

Copies of bills and/or receipts may be mailed to:

For Medical Requests:
Upper Peninsula Health Plan
853 West Washington Street
Marquette, MI 49855

To make sure you are giving us all the information we need to make a decision, you can fill out our UPHP Claim Reimbursement Form to make your request for payment.

For Pharmacy Requests:
Magellan Rx Management
Direct Member Reimbursement
2520 Industrial Row Drive
Troy, MI 48084

To make sure you are giving Magellan Rx Management all the information they need to make a decision, you can fill out the Magellan Rx Management Direct Member Reimbursement Form to make your request for payment.

If you have questions, call UPHP Customer Service at 1-877-349-9324 (TTY: 711), seven days a week from 8 a.m. to 9 p.m. Eastern time.  The call is free.

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Page Last Updated: 10/10/2018