Provider and Pharmacy Search – MI Health Link

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.