UPMC for Life HMO/PPO Plan Provider Directory

2016

UPMC for Life HMO/PPO Plan Provider Directory

This directory provides a list of UPMC for Life's network providers.

This directory is for the following counties in our 29-county service area:

Pennsylvania

Allegheny Beaver Butler Fayette Greene

Washington Westmoreland

This directory is current as of August 2015. Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. To get the most upto-date information about UPMC for Life's network providers in your area, you can visit medicare or call our Member Service Department at 1-877-539-3080, seven days a week from 8 a.m. to 8 p.m.* TTY users should call 1-800-361-2629.

UPMC for Life has a contract with Medicare to provide HMO and PPO plans. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., and UPMC Health Benefits Inc. The pharmacy and provider network may change at any time. You will receive notice when necessary.

This document may be available in an alternative format such as Braille, larger print, or audio; please call Member Services at the phone number listed above.

Y0069_16_2002a Accepted

Section 1 -- Introduction

This directory provides a list of UPMC for Life's network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

If you join a UPMC for Life HMO plan, you must use network providers to obtain medical care and services. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP). The term "PCP" will be used throughout this directory. Generally, you must get your health care services from your PCP. A PCP is not required with the UPMC for Life PPO plans, but we still encourage you to select a primary care physician.

A PCP should be your first point of contact for undiagnosed health concerns or health problems and routine health care needs. Besides providing much of your care, your PCP will help arrange or coordinate the rest of the covered services you get as a plan member. This includes your x-rays, laboratory tests, therapies, care from doctors who are specialists, hospital admissions, and follow-up care. Referrals are not required with UPMC for Life HMO or PPO plans, but your PCP should be your primary resource to use when seeking specialist and hospital care and coordination of your medical services.

The "network providers" listed in this directory have agreed to provide you with your: health care/ dental/vision/fitness services. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from non-network providers, such as for emergency, urgent care, or out-of-area renal dialysis. The UPMC for Life PPO plans also pay for covered services when you visit a doctor or medical facility that is not included in the UPMC for Life network. Except for an emergency or urgent care services, the PPO plan out-of-network cost-sharing may be higher than if network providers are used.

How to submit a paper claim

UPMC for Life network providers bill us directly for Medicare-covered medical services that you receive. If an out-of-network provider sends you a bill, please call Member Services or send the bill to us for payment. We will pay your doctor or reimburse you for our share of the bill and will let you know what, if anything, you must pay (e.g., copayments, coinsurance or deductible). If you have any questions about how to submit a paper claim, please contact us. Our contact information appears on the front and back cover pages. Or you can mail your claim to: UPMC for Life, P.O. Box 2997, Pittsburgh, PA 15230.

What is a medical emergency and what is covered?

A medical emergency is when you believe that your health is in serious danger. A medical emergency includes severe pain, a bad injury, a sudden illness, or a medical condition that is quickly getting much worse. You may get covered emergency medical care whenever you need it from the nearest hospital or provider, anywhere in the world. You don't need to get approval first from UPMC for Life or your doctor.

If you have an emergency, our plan will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. After the emergency is over, you are entitled to follow-up care to be sure your condition continues to be stable. Your followup care will be covered by our plan. If your emergency care is provided by non-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

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With the UPMC for Life HMO plans you must use plan providers except in emergency or urgent care situations, or for out-of-area renal dialysis services. If you obtain routine care from out-of-network providers, neither Medicare nor UPMC for Life will be responsible for the costs. With the UPMC for Life PPO plans, the outof-network cost-sharing may be higher than in-network, with the exception of emergency and urgent care.

What is the service area for UPMC for Life?

The counties in our service area are listed

below.

Pennsylvania: Allegheny Armstrong Beaver Bedford Blair Butler Cambria Cameron Clarion Clearfield Crawford Elk Erie Fayette

Forest Greene Huntingdon Indiana Jefferson Lancaster Lawrence McKean Mercer Potter Somerset Venango Warren Washington Westmoreland

How do you find UPMC for Life providers in your area?

This is a regional directory that contains UPMC for Life network providers listed by provider type and county. All network PCPs and specialists are NOT listed in this directory. If you want to receive additional provider information for a county that may not be included in this directory, please contact us. Our contact information appears on the front and back cover pages.

There are provider sections in this directory, such as participating hospitals and cancer centers, where we list every hospital or facility within our service area to provide you with the most comprehensive network information. There is also an alphabetical index in the back of the directory for your convenience.

The UPMC for Life online provider directory provides the most updated provider information. Our website at medicare includes additional information, such as a doctor's area(s) of specialty (or group practice), accepting new patients, office locations, board certifications, hospital admitting privileges, gender, and languages spoken.

If you have questions about UPMC for Life or require assistance in selecting a PCP, please call our Member Service Department at 1-877-539-3080, seven days a week from 8 a.m. to 8 p.m.* TTY users should call 1-800-361-2629. Or visit medicare.

*Our hours of operation change twice a year.

You can call us October 1 through

February 14, seven days a week from 8 a.m. to

8 p.m. From February 15 through

September 30, you can call us Monday through

Friday from 8 a.m. to 8 p.m., and Saturday from

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8 a.m. to 3 p.m.

UPMC for Life Allegheny County Service Area

Because of the large number of providers in Allegheny County, we have divided the provider listings into five geographic sections: Allegheny Central, North, South, East, and West. Find your ZIP code under the geographic section listed below and then reference the providers listed in that section for PCPs, Obstetrics & Gynecology, and Specialists.

Allegheny County Service Areas

CENTRAL

15201 Pittsburgh 15203 15204 15210 15211 15212 15213 15214 15216 15217 15219 15220 15222 15224 15226 15232 15233 15260 15261 15282

EAST

15018 Buena Vista 15028 Coulters 15035 East McKeesport 15047 Greenock 15075 Rural Ridge 15104 Braddock 15110 Duquesne 15112 East Pittsburgh 15120 Homestead 15130 McKeesport 15131 15132 15134 15135 15137 North Versailles 15139 Oakmont 15140 Pitcairn 15145 Turtle Creek 15146 Monroeville 15147 Verona 15148 Wilmerding 15206 Pittsburgh 15208 15218 15221 15235 15239 iv15240

NORTH

15006 Bairdford 15007 Bakerstown 15014 Brackenridge 15015 Bradfordwoods 15024 Cheswick 15030 Creighton 15032 Curtisville 15044 Gibsonia 15049 Harwick 15051 Indianola 15056 Leetsdale 15065 Natrona Heights 15076 Russellton 15084 Tarentum 15086 Warrendale 15090 Wexford 15091 Wildwood 15095 Warrendale 15096 Warrendale 15101 Allison Park 15116 Glenshaw 15127 Ingomar 15143 Sewickley 15144 Springdale 15202 Pittsburgh 15209 15215 15223 15225 15229 15237 15238 15285

SOUTH

15020 Bunola 15025 Clairton 15034 Dravosburg 15037 Elizabeth 15038 Elrama 15045 Glassport 15088 West Elizabeth 15102 Bethel Park 15122 West Mifflin 15123 West Mifflin 15129 South Park 15133 McKeesport 15200 Pittsburgh 15207 15227 15228 15230 15234 15236 15252 15254 15257 15258 15259 15262 15270 15278 15281

WEST

15017 Bridgeville 15031 Cuddy 15046 Crescent 15064 Morgan 15071 Oakdale 15082 Sturgeon 15106 Carnegie 15108 Coraopolis 15126 Imperial 15136 McKees Rocks 15142 Presto 15189 Sewickley 15205 Pittsburgh 15231 15241 15242 15243 15244 15250 15251 15253 15255 15263 15264 15265 15266 15267 15268 15272 15274 15275 15276 15277 15279 15283 15286 15290 15295

Allegheny County Service Areas

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