Welcome to the United Oustanding Providers frequently asked questions. We have created this list of our most commonly asked question to server you better. If you have a question not answered on this list please use our contact form.
1: What is UOP?
2: What is the difference between an HMO and a PPO?
3: What is the difference between Emergency and Urgent Care services?
4: When is it appropriate to seek Emergency Room treatment?
5: Should my teenager see a pediatrician?
6: How can patients choose their PCP (Primary Care Physicians)?
7: How does a referral and an authorization differ (HMO only)?
8: At what time can I see UOP specialist without a referral?
9: Can I request services using "out-of-network" providers or facilities?
10: With which health plans do physicians contract through UOP?
11: What is the difference between a Family Practice and an Internal Medicine physician?
12: What can I do if I am dissatisfied with my physician? How can I request to be transferred?
What is UOP?
UOP is a physician organization comprised of nearly 1000 physicians who are focused on quality and efficiency in the delivery of healthcare. At UOP, our approach to healthcare is clear that is to provide a certified system that works for everyone. Over 960 physicians have joined UOP in a shared commitment to provide the right care, at the right time, in the right setting. What we've come to discover is, in the end, everybody wins.
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What is the difference between an HMO and a PPO?
The primary difference between an HMO and a PPO is that the HMO product requires that, in most instances, you obtain a referral when seeking specialty care. A PPO allows you to direct your own specialty care within a contracted network of physicians, or a non-contracted physician at a higher out of pocket cost.
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What is the difference between Emergency and Urgent Care services?
Emergency Services are required as a result of unforeseen injury or acute illness for which delay in treatment would result in a permanent physical impairment or loss of life. Chest pains or excessive bleeding may be an example of Emergency Services.
The term emergency medical condition means manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent lay person with an average knowledge of health and medicine, should reasonable expect the absence of immediate medical or psychiatric attention to result in: 1) serious jeopardy to the health of the individual (or unborn child); 2) serious impairment to bodily functions; or 3) serious dysfunction of an bodily organ or part.
Urgent Care is defined as those services required as a result of unforeseen injury or acute illness that requires immediate attention, for which delay in treatment would NOT result in a permanent physical impairment or loss of life.
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When is it appropriate to seek Emergency Room treatment?
If you experience a life threatening injury or sudden illness for which delay in treatment would result in permanent physical impairment or loss of life, you should immediately call 911 or go to the Emergency Room. Chest pains, excessive bleeding and broken bones would be situations where your condition would warrant emergency room treatment. In all other scenarios, contact your PCP who has coverage 24 hours a day/seven days a week, and describe your symptoms. You will be directed to the appropriate level of care.
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Should my teenager see a pediatrician?
Most pediatricians treat children up to the age of 18, with some exceptions. To avoid having to change the teenager's PCP once he or she reaches that age, you may choose to establish a relationship with an adult PCP prior to your teenager turning 18.
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How can patients choose their PCP (Primary Care Physicians)?
Patients, who have HMO insurance, will need to choose a PCP who is accountable for synchronizing all of your healthcare needs, including referrals for specialty care and hospital care. Our online physician directory will help visitors to learn more about a physicians education, specialty, or location. Toward formally assigning a PCP and ID card with your PCP selection, you must contact your health plans member services department directly.
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How does a referral and an authorization differ (HMO only)?
When your physician cannot provide you the treatment you need, he or she refers you to another in-network UOP physician. The provider must then file a referral; a referral is good for up to six months from the date of issue. An authorization is different from a referral because you must authorize certain medical treatments before you can receive them. An out of network authorization is a request for service that requires proper evaluation by UOP.
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At what time can I see UOP specialist without a referral?
The following do not require a referral from the PCP if provided within the UOP HMO network:
Women may self-refer to a UOP obstetrician/gynecologist.
Women may self-refer to UOP facilities for annual mammogram screenings.
Patients may be referred to a UOP podiatrists and ophthalmologists with only a verbal approval from their PCP.
PPO members may self refer for any specialty care within the UOP PPO physician network.
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Can I request services using "out-of-network" providers or facilities?
UOP has excellence "in-network" providers and facilities for all services. In the occurrence that a particular service is not available in-network, providers will need to request prior authorization from UOP to use "out-of-network" services. If not provided in an emergency circumstance, "out-of-network" services will generally not be covered unless pre-approved. UOPs objective is to guarantee you receive high-quality care from outstanding providers in a timely manner.
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With which health plans do physicians contract through UOP?
Beaumont Employee Health Plan (BEHP)
Blue Care Network HMO
Blue Care Network Medicare Advantage
Care Choices HMO
Preferred Choices PPO
Health Alliance Plan HMO
Health Alliance Plan PHP
Health Alliance Plan Senior Plus HMO
Health Alliance Plan Medicare PPO
Health Alliance Wayne County Four Star
Humana PPO
Humana Medicare PPO
M-Care (BCN has purchase the M-CARE HMO and M-CAID, M-CARE contracts will remain in effect throughout 2007)
Molina Health Plan
OHSCare
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What is the difference between a Family Practice and an Internal Medicine physician?
An Internal Medicine physician cares for generally adults 18 and above and specializes in the diagnosis and treatment of disease.
A Family Practice physician treats both adults and children. Family Practice physicians are skilled in treating family issues and relationships, and may provide general gynecology services.
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What can I do if I am dissatisfied with my physician? How can I request to be transferred?
A complaint for the purposes of this policy is defined as "An expression of dissatisfaction, however made, about the standard of service, actions or lack of action by the physician, its staff or billing company". By letting UOP know you will help us make improvements. Filing a request to transfer could be done through you Member Service Department with your health plan. The number should be found on the back of your health plan enrollment card.
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