Provider Search – MI Health Link

• Upper Peninsula Health Plan (UPHP) MI Health Link (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees.
• If you would like further information on a provider’s race or ethnicity, please call UPHP Customer Service at 1-877-349-9324 (TTY:711), Monday through Friday from 8 a.m. to 9 p.m. Eastern Time and we will help you.
• The searchable directory lists health care professionals (such as doctors, nurse practitioners, psychologists, and hearing, dental, or vision specialists, and therapists), facilities (such as hospitals or clinics), and support providers (such as Adult Day Health and Home Health providers) that you may use as a UPHP MI Health Link member. We also list the pharmacies that you may use to get your prescription drugs.
• We will refer to these groups as “network providers” in this Directory. These providers signed a contract with us to provide you services. This is a list of UPHP MI Health Link’s network providers for the Upper Peninsula of Michigan, including Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, and Schoolcraft counties.
• You can also get this information for free in other formats, such as large print, braille or audio. Call 1-877-349-9324 (TTY: 711), Monday through Friday from 8 a.m. to 9 p.m. Eastern Time. The call is free.

This searchable directory is updated daily, but some UPHP MI Health Link providers in our network may no longer be accepting new members. If you are having trouble finding a provider who will accept new members, call UPHP Customer Service at 1-877-349-9324 (TTY: 711), Monday through Friday from 8 a.m. to 9 p.m. Eastern Time and we will help you.

This section explains key terms in the UPHP MI Health Link Provider and Pharmacy Directory.

• Providers are health care professionals and support providers such as doctors, nurse practitioners, psychologists, hearing, dental, or vision specialists, nurses, pharmacists, therapists, and other people who provide care and services. Services include medical care, long term supports and services (LTSS), supplies, prescription drugs, equipment and other services.
  • The term “providers” also includes facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long term supports and services.
  • Providers that are a part of our plan’s network are called network providers.
• Network providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you use a network provider, you usually pay nothing for covered services.
• A Primary Care Provider (PCP) is a physician, physician assistant or nurse practitioner who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time. Your PCP will also give you a referral if you need a specialist or other provider.
• Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
  • Oncologists care for patients with cancer.
  • Cardiologists care for patients with heart conditions.
  • Orthopedists care for patients with certain bone, joint, or muscle conditions.
• You may need a referral for a specialist or someone that is not your PCP. A referral means that your primary care provider (PCP) must give you approval before you can go to someone that is not your PCP. If you don’t get a referral, UPHP MI Health Link may not cover the service.
  • Referrals from your network PCP are not needed for:
    • Emergency care;
    • Urgently needed care;
    • Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are outside the plan’s service area; or
    • Services from a women’s health specialist.
  • Additionally, if you are eligible to get services from Indian health providers, you may use these providers without a referral. We must pay the Indian health provider for those services even if they are out of our plan’s network.
  • More information on referrals is available in Chapter 3 of the Member Handbook.
• Your provider may need prior authorization or an approval from UPHP MI Health Link before you get certain services. Covered services that need prior authorization are marked in the Benefits Chart in Chapter 4 of the Member Handbook. Some drugs are covered only if you get prior authorization from us. Covered drugs that need prior authorization are marked in the List of Covered Drugs.
• You also have access to a Care Coordinator and a Care Team that you choose.
  • A Care Coordinator helps you manage your medical providers and services. Your care coordinator is the one main person who works with you, with the health plan, and with your care providers to make sure you get the care you need.
  • Your Care Team includes you, your chosen allies or legal representative, PCP, Care Coordinator, LTSS Coordinator and /or Prepaid Inpatient Health Plan (PIHP) Supports Coordinator (as applicable), and others as needed. Everyone on the Care Team works together to make sure your care is coordinated. This means that they make sure tests and labs are done once and the results are shared with the appropriate providers. It also means that your PCP should know all medicines you take so that they can reduce any negative effects. Your PCP will always get your permission before sharing your medical information with other providers.

You can get services from any provider who is in our network and accepting new members.

First, you will need to choose a PCP. You may be able to have a specialist act as your PCP. This could be an obstetrician, gynecologist, or internal medicine doctor. Call UPHP Customer Service at 1-877-349-9324 (TTY: 711) before choosing a specialist as your PCP.

To choose a PCP, refer to the list of Primary Care Providers and choose a provider:

• that you use now, or
• who has been recommended by someone you trust, or
• whose offices are easy for you to get to.

If you want help in choosing a PCP, please call UPHP Customer Service at 1-877-349-9324 (TTY: 711), Monday through Friday from 8 a.m. to 9 p.m. Eastern Time. The call is free.

If you have questions about whether we will pay for any medical service or care that you want or need, call UPHP Customer Service and ask before you get the service or care.

As a UPHP MI Health Link member, you may be able to get long term supports and services (LTSS), such as home health, personal care, nursing home and home and community based services (adult day program, respite, expanded community living supports, preventive nursing services, private duty nursing, and other services). LTSS help people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital.

You should discuss LTSS with you Care Coordinator to determine which services you qualify for and how to access them.

You may need a referral for someone who is not a Primary Care Provider (PCP).

You must get all of your covered services from providers within our network. If you use providers who are not in UPHP MI Health Link’s network (without prior authorization or approval from us), then you will have to pay the bill.

The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. You can also go outside the plan for other non-emergency services if UPHP MI Health Link gives you permission first.

• You may change providers within the network at any time during the year. If you have been using one network provider, you do not have to keep using that same provider. For some providers, you may need a referral from your PCP.
• UPHP MI Health Link works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, the list of network providers in this Directory includes information about the accommodations they provide.
• If you need a provider and are not sure if they offer the accommodations you need, UPHP MI Health Link can help you. Talk to your Care Coordinator for assistance.

How to find UPHP MI Health Link providers in your area

You can find a network provider nearest your home in this list, by finding the provider grouped first by specialty, then sorted alphabetically by county, then by city, zip code and then by provider name.

You may receive services from any of the providers on this list. For some, you may need a referral from your PCP.  

List of network providers

This searchable directory of UPHP MI Health Link’s network providers contains:

• Health care professionals including primary care providers, who may be physicians, physician assistants, or nurse practitioners; hearing, dental, or vision specialists
• Facilities including hospitals; urgent care centers; skilled nursing facilities/nursing facilities; Prepaid Inpatient Health Plan (PIHP) facilities for needs related to behavioral health, intellectual/developmental disability, and/or substance use; and
• Support providers including adult day programs; assistive technology; chore services; community transitions; environmental modifications; home-delivered meals; LTSS and non-LTSS home health agencies; medical supplies; non-medical transportation; personal care; preventive nursing; private duty nursing; and/or respite care.

In addition to contact information, provider listings also include specialties and skills, for example, such as languages spoken or completion of cultural competence training.

Cultural competence training is additional instruction for our health care providers that helps them better understand your background, values, and beliefs to adapt services to meet your social, cultural, and language needs.

This searchable directory provides a list of pharmacies in UPHP MI Health Link’s network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

UPHP MI Health Link members must use network pharmacies to get prescription drugs except in emergency or urgent care situations.

• If you use an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service.
• Read the UPHP MI Health Link Member Handbook for more information.

This Directory may not list all network pharmacies. We may have added or removed some network pharmacies from our plan after we published this Directory.

To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UPHP MI Health Link’s List of Covered Drugs.

How to Identify Pharmacies in UPHP MI Health Link’s Network
Along with retail and chain pharmacies, your plan’s network of pharmacies includes:

• Home infusion pharmacies prepare prescription drugs that are given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.
• Long-term care (LTC) pharmacies serve residents of long-term care facilities, such as nursing homes.
• Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies

You are not required to continue using the same pharmacy to fill your prescriptions.

Long-term Supplies of Prescriptions
UPHP MI Health Link does not offer a long term supply of drugs.

Pharmacy Types

• Retail and Chain Pharmacies
• Home infusion pharmacies
  To determine if you are eligible to use this pharmacy for your home infusion therapy or to get more information call the phone number associated with that pharmacy.

• Long-term care pharmacies
  Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under UPHP MI Health Link through the facility’s pharmacy or another network pharmacy. To learn more about drug coverage in special cases, refer to Chapter 5 of the Member Handbook,

• Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) pharmacies
  Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through UPHP MI Health Link’s (Medicare-Medicaid Plan) pharmacy network. Those other than Native Americans and Alaskan Natives may be able to use these pharmacies under limited circumstances (e.g., emergencies). Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies are not accessible to all members.