TO USE THE GROUP
Medical Group is a leading provider of health care services
comprised of highly qualified physicians who are in individual
private practices or medical groups. Upland Medical Group
is supported by an experienced administrative management company,
ProMed Health Care Administrators (ProMed HCA), who understands
the HMO/Managed Care system. ProMed HCA is staffed with qualified
health professionals who are available to answer your questions
regarding the Network doctors and services. Your Primary Care
Physician (PCP), often referred to as your "family doctor",
is responsible for managing and coordinating your medical
care. Upland Medical Group's physicians are Board Certified
or Board Eligible in the areas of Family Practice, General
Practice, Internal Medicine, or Pediatrics. The Upland Medical
Group Primary Care Physician you choose will coordinate all
of your health care needs including routine office visits,
physicals, referral to specialists, and authorizations of
emergency care. If you recently selected a Upland Medical
Group doctor you may call the office to schedule an appointment.
In order to ensure you receive the best possible treatment,
be sure to tell your doctor everything you can about your
symptoms, any medications you are taking, and ask any necessary
questions about your treatment options. If you are over 18,
you must select either a Family Practice, General Practice,
or Internal Medicine physician. Most Family Practice physicians
will also treat pediatric patients.
MEDICAL GROUP HOURS OF OPERATION
office is open 8:00 AM - 5:00 PM, Monday through Friday
Upland Medical Group office number is : (909) 291-4400
The Upland Medical Group 800 (toll free ) number is: (800)
office is closed on the following holidays:
Year's Eve Day
1/2 day New Year's Day
day Christmas Day
Medical Group's staff, including UM personnel, are available
during normal hours of operation.
HOURS STAFF AVAILABILITY
normal business hours, members, vendors and/or providers can
contact the IPA for urgent or emergent medical issues . They
are to call the normal business telephone number and can follow
the instructions to reach the on call nurse for assistance.
Business hours: Upland Medical Group can provide telephone
translation services with staff or ATT Language line
HCA and their affiliated IPAs do not engage in economic credentialing
or in promoting penalties on physicians who provider quality
health care and service. Any compensation plans do not include
incentives for inappropriate review decision. (NCQA UM 13)
HCA provides access to staff for members and practitioners
seeking information about the UM process and the authorization
of care. The following communication services are provided
for practitioners and members;
- Availability of staff at least 8 hours a day during normal
business hours/days for inbound calls regarding UM issues.
ProMed HCA accomplishes this via telephone, fax and/or electronic
mail during normal business hours.
of staff to receive inbound communication after normal business
hours regarding UM issues. After regular business hours,
members and/or providers are directed to the case manager,
a licensed health care professional, who is on call via
the ProMed HCA answering exchange.
communication from staff regarding inquiries about UM during
normal business hours, unless otherwise agreed upon. ProMed HCA
accomplishes this via telephone, fax and/or electronic mail
during normal business hours.
identifies themselves by name, title and organization name
when initiating or returning calls regarding UM issues
toll free number or staff that accept collect calls regarding
UM issues. ProMed HCA maintains a toll free number. This is
available to members via the new member letter and on the
ProMed HCA website . Providers can also access the ProMed HCA website
for this information
to staff for callers with questions about the UM process.
Methods of access are as indicated above.
ProMed HCA Internet website contains this information regarding
ProMed HCA access for members and practitioners seeking information
about the UM process and the authorization of care. The
website information includes location, telephone number,
toll free telephone number, hours and days of operations
and how to access staff after regular business hours.
about UM decisions beyond the confirmation of approved or
denied care are forwarded to UM staff for triage and handling.
During business hours, these inquiries are forwarded to
the Authorization Department and/or case managers. After
regular business hours, members and/or providers are directed
to the case manager, who is on call via the ProMed HCA answering
TO A SPECIALIST
your medical condition requires you to see a specialist, your
Upland Medical Group PCP will authorize the referral through
the Upland Medical Group of specialist physicians. Authorizations
are usually approved within five days for non-emergency services,
and within 24 hours for urgent cases. In certain cases, your
doctor will directly refer you for specialty care without
waiting for approval. ProMed HCA will review your health plan
benefits to verify coverage prior to approval.
AND URGENT MEDICAL CARE
is important to understand the difference between a medical
emergency and a non life-threatening situation requiring medical
care. An emergency is any sudden, serious and unexpected acute
illness, injury or condition which would permanently endanger
your health if medical treatment is not received immediately.
Examples of medical emergencies are severe chest pains, convulsions
or seizures, heavy bleeding or unconsciousness. Some conditions
like extreme flu symptoms, or a sprained ankle, may be serious
but do not require emergency care. In case of a life-threatening
illness or injury call 911 or go directly to the nearest emergency
room. If you receive emergency medical care, present your
health plan card to the hospital and request they contact
your PCP. You must contact Upland Medical Group within 48
hours of your hospital visit and all follow-up care must be
coordinated by your Upland Medical Group PCP. If you seek
medical treatment for non-emergency care outside of the Upland
Medical Group, you may be financially responsible for any
services you receive. For routine urgent care calls, contact
your Upland Medical Group doctor during regular office hours.
Calls received outside of regular office hours will be handled
by the on-call physician.
TESTS TREATMENTS AND HOSPITALIZATION
Upland Medical Group PCP will arrange for laboratory, radiology,
and diagnostic services as well as any hospitalization that
may be required. Upland Medical Group physicians are staff
members at full-service, acute care hospitals which provide
state-of-the-art medical services. Senior members can self-refer
to ProMed's affiliated hospitals for mammography screenings
only. Please call a ProMed HCA Customer Service Representative
at (909) 291-4400 if you need more information.
minimal co-payment may be required for some professional and
hospital services. Co-payments are usually required at the
time of service by the physician's office, pharmacy, or medical
facility. Please contact a ProMed HCA Customer Service Representative
if you have questions regarding your co-payment requirements.
schedule an appointment with your PCP, consult the Upland
Medical Group Primary Care Physician Directory or the front
of your health plan membership card and contact your doctor's
office. You should schedule a "get acquainted" visit
with your Upland Medical Group PCP within three months and
arrange for a physical examination after your first visit.
Remember to contact your doctor immediately if you can not
make a scheduled appointment.