UPMC for Life Dual (HMO SNP) Provider Directory This Directory Provides a List of UPMC for Life Dual’S Network Providers
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2016 UPMC for Life Dual (HMO SNP) Provider Directory This directory provides a list of UPMC for Life Dual’s network providers. This directory is for the following counties in our 28-county service area: Pennsylvania Armstrong Crawford Lawrence Bedford Elk McKean Blair Erie Mercer Cambria Forest Potter Cameron Huntingdon Somerset Clarion Indiana Venango Clearfield Jefferson Warren 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 up-to-date information about UPMC for Life Dual’s network providers in your area, you can visit www.upmchealthplan.com/snp or call our Member Services Department at 1-800-606-8648, seven days a week from 8 a.m. to 8 p.m.* TTY users should call 1-866-407-8762. UPMC for Life Dual is an HMO SNP plan with a Medicare contract and a contract with the Pennsylvania Medical Assistance (Medicaid) program. Enrollment in UPMC for Life Dual depends on contract renewal. UPMC for Life Dual is a product of and operated by UPMC for You 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_3000 Accepted Section 1 — Introduction This directory provides a list of UPMC for deductible). If you have any questions about Life Dual’s network providers. To get detailed how to submit a paper claim, please contact information about your health care coverage, us. Our contact information appears on the please see your Evidence of Coverage. front and back cover pages. Or, you can mail your claim to: UPMC for Life Dual, Member You will have to choose one of our network Services Department, U.S. Steel Tower, 600 providers who are listed in this directory to be Grant Street, Pittsburgh, PA 15219. your Primary Care Physician (PCP). The term “PCP” will be used throughout this directory. What is a medical emergency and Generally, you must get your health care services what is covered? from your PCP. A medical emergency is when you believe that your health is in serious danger. A medical A PCP should be your first point of contact for emergency includes severe pain, a bad injury, undiagnosed health concerns or health problems a sudden illness, or a medical condition that and routine health care needs. Besides providing is quickly getting much worse. You may get much of your care, your PCP will help arrange covered emergency medical care whenever or coordinate the rest of the covered services you you need it from the nearest hospital or get as a plan member. This includes your x-rays, provider, anywhere in the world. You don’t laboratory tests, therapies, care from doctors who need to get approval first from UPMC for Life are specialists, hospital admissions, and follow-up Dual or your doctor. care. Referrals are not required with UPMC for Life Dual, but your PCP should be your primary If you have an emergency, our plan will resource to use when seeking specialist and talk with the doctors who are giving you hospital care and coordination of your medical emergency care to help manage and follow services. up on your care. The doctors who are giving you emergency care will decide when your The “network providers” listed in this directory condition is stable and the medical emergency have agreed to provide you with your health care, is over. After the emergency is over, you are vision and dental services. You may go to any of entitled to follow-up care to be sure your our network providers listed in this directory. If condition continues to be stable. Your follow- you have been going to one network provider, you up care will be covered by our plan. If your are not required to continue going to that same emergency care is provided by non-network provider. In some cases, you may get covered providers, we will try to arrange for network services from non-network providers, such as for providers to take over your care as soon as your emergency or urgent care situations, or for out- medical condition and the circumstances allow. of-area renal dialysis or other services. You must use plan providers except in an How to submit a paper claim emergency, urgent care situations, or for UPMC for Life Dual network providers bill us out-of-area renal dialysis. If you obtain directly for Medicare-covered medical services routine care from out-of-network providers, that you receive. If an out-of-network provider neither Medicare nor UPMC for Life Dual sends you a bill, please call Member Services and will be responsible for the costs. they will send you a claim form. Once the claim form is received, send the claim form and the bill to us for payment consideration. We may 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 i What is the service area for There are provider sections in this directory, UPMC for Life Dual? such as participating hospitals and cancer The counties in our service area are listed centers, where we list every hospital or facility below. within your service area to provide you with the most comprehensive network information. Pennsylvania counties: There is also an alphabetical index in the back Allegheny Forest of the directory for your convenience. Armstrong Greene Beaver Huntingdon The UPMC for Life Dual online provider Bedford Indiana directory provides the most updated Blair Jefferson provider information. Our website at Butler Lawrence www.upmchealthplan.com/snp includes Cambria McKean additional information, such as a doctor’s Cameron Mercer area(s) of specialty (or group practice), Clarion Potter accepting new patients, office locations, board Clearfield Somerset certifications, hospital admitting privileges, Crawford Venango gender, and languages spoken. We update the Elk Warren online provider directory weekly with the latest Erie Washington changes to the UPMC for Life Dual network. Fayette Westmoreland If you have questions about UPMC for Life How do you find UPMC for Life Dual or require assistance in selecting a PCP, Dual providers in your area? please call our Member Services Department at This is a regional directory that contains 1-800-606-8648, seven days a week from 8 a.m. UPMC for Life Dual network providers for the to 8 p.m.* TTY users should call 1-866-407- counties that are located closest to your home 8762. Or, visit www.upmchealthplan.com/snp. address. 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 Member Services at the phone number listed below or visit our website at www.upmchealthplan.com/snp. *Our hours of operation change twice a year. You can call us October 1 through February 14, from 8 a.m. to 8 p.m., seven days a week. From February 15 through September 30, you can call us from 8 a.m. to 8 p.m., Monday through Friday, ii and from 8 a.m. to 3 p.m., Saturday. 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 region listed below and then reference the providers listed in that region for PCPs, Obstetrics & Gynecology, and Specialists. Allegheny County Service Areas CENTRAL NORTH SOUTH WEST 15201 Pittsburgh 15006 Bairdford 15020 Bunola 15017 Bridgeville 15203 15007 Bakerstown 15025 Clairton 15031 Cuddy 15204 15014 Brackenridge 15034 Dravosburg 15046 Crescent 15210 15015 Bradfordwoods 15037 Elizabeth 15064 Morgan 15211 15024 Cheswick 15038 Elrama 15071 Oakdale 15212 15030 Creighton 15045 Glassport 15082 Sturgeon 15213 15032 Curtisville 15088 West Elizabeth 15106 Carnegie 15214 15044 Gibsonia 15102 Bethel Park 15108 Coraopolis 15216 15049 Harwick 15122 West Mifflin 15126 Imperial 15217 15051 Indianola 15123 West Mifflin 15136 McKees Rocks 15219 15056 Leetsdale 15129 South Park 15142 Presto 15220 15222 15065 Natrona Heights 15133 McKeesport 15189 Sewickley 15224 15076 Russellton 15200 Pittsburgh 15205 Pittsburgh 15226 15084 Tarentum 15207 15231 15232 15086 Warrendale 15227 15241 15233 15090 Wexford 15228 15242 15260 15091 Wildwood 15230 15243 15261 15095 Warrendale 15234 15244 15282 15096 Warrendale 15236 15250 15101 Allison Park 15252 15251 EAST 15116 Glenshaw 15254 15253 15018 Buena Vista 15127 Ingomar 15257 15255 15028 Coulters 15143 Sewickley 15258 15263 15035 East McKeesport 15144 Springdale 15259 15264 15047 Greenock 15202 Pittsburgh 15262 15265 15075 Rural Ridge 15209 15270 15266 15104 Braddock 15215 15278 15267 15110 Duquesne 15223 15281 15268 15112 East Pittsburgh 15225 15272 15120 Homestead 15229 15274 15130 McKeesport 15237 15275 15131 15238 15276 15132 15285 15277 15134 15279 15135 15283 15137 North Versailles 15286 15139 Oakmont 15290 15140 Pitcairn 15295 15145 Turtle Creek 15146 Monroeville 15147 Verona 15148 Wilmerding 15206 Pittsburgh 15208 15218 15221 15235 15239 15240 iii Allegheny County Service Areas iv Section 2 — List of Network Providers Table of Contents Network Providers Count Page Participating Hospitals .....................................................................(65 Providers) ............................................ 3 UPMC