HOW TO USE THE GROUP

Upland 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.

UPLAND MEDICAL GROUP HOURS OF OPERATION

The 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) 281-8886

HOLIDAY SCHEDULE

The office is closed on the following holidays:

• New Year's Eve Day
• 1/2 day New Year's Day
• President's Day
• Memorial Day
• 4th of July
• Labor Day
• Thanksgiving Day
• Day after Thanksgiving
• Christmas Eve Day
• 1/2 day Christmas Day

STAFF AVAILABILITY

Upland Medical Group's staff, including UM personnel, are available during normal hours of operation.

AFTER HOURS STAFF AVAILABILITY

After 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.

TRANSLATION SERVICES

Normal Business hours: Upland Medical Group can provide telephone translation services with staff or ATT Language line

UTILIZATION MANAGEMENT

ProMed 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)

ProMed 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;

1. 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.
2. Ability 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.
3. Outbound 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.
4. Staff identifies themselves by name, title and organization name when initiating or returning calls regarding UM issues
5. A 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
6. Access to staff for callers with questions about the UM process. Methods of access are as indicated above.
7. The 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.
8. Inquires 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 exchange.

REFERRAL TO A SPECIALIST

If 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.

EMERGENCIES AND URGENT MEDICAL CARE

It 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.

SPECIAL TESTS TREATMENTS AND HOSPITALIZATION

Your 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.

YOUR CO-PAYMENT

A 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.

MAKING APPOINTMENTS

To 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.