Access to Care

When you joined UPMC for You, you spoke with a representative who gave you information on choosing a PCP. If you did not choose a PCP when you signed up, call the Health Care Concierge team. We can give you a list of providers to help you decide the one who is right for you. If you do not contact the Health Care Concierge team, a PCP will automatically be assigned to you.

PCPs and obstetrician-gynecologists (ob-gyns) must have at least 20 office hours per week.

The expected waiting time is 30 minutes or up to one hour if the provider receives an unexpected urgent visit or is treating someone with a difficult medical need.

All provider offices must meet the Americans with Disabilities Act (ADA) accessibility guidelines.

UPMC for You wants to be sure you are getting health care when you need it. That is why there are standards for appointments at the provider’s office. Your health care needs determine the kinds of visits you need and how soon providers should see you.

It is important that you get to know your PCP. Call and make an appointment for a visit soon after you become a member. When you make the appointment, tell your PCP if you have any medical insurance in addition to UPMC for You. You should give your PCP as much information as possible about your health. This includes family history, past illnesses, medicines you are taking, and any current health problems or concerns you have.

Your PCP selection is effective immediately after you call the Health Care Concierge team and tell us the name of your PCP. We will send you a new UPMC for You ID card with the name and phone number of your PCP. Keep your current UPMC for You ID card until you get your new one. Your PCP is always the first person you should call for routine or nonemergency health care needs.

A medical condition presenting with acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in: (a) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part.

Here are some examples of emergencies:

• Heart attack
• Chest pain
• Severe headache (a possible sign of stroke)
• Severe bleeding
• Unconsciousness
• Poisoning
• Sudden loss of feeling or not being able to move
• Strong feeling that you may kill yourself or another person
• Severe pain

If you have an emergency, go to the nearest emergency room, call 911, or call your local ambulance service. The emergency room must perform an appropriate initial screening examination to see if an emergency condition exists. The hospital will conduct more examinations and treatments to stabilize your medical condition. If the hospital finds you need to be transferred to another facility, they will advise you of the risks and benefits, get your written consent, and get an authorization from UPMC for You. You must call your PCP for any follow-up care needed after your visit to the emergency room. If you need help arranging care, please call the Health Care Concierge team. If you get follow-up care with someone other than your PCP without a referral, UPMC for You may not pay the bill. If you have questions about a bill, please call the Health Care Concierge team.

If you have an emergency and need to be admitted to the hospital, you should tell your PCP. Call within two days or as soon as you or a family member can call. If you are admitted to a hospital that does not accept UPMC for You members, you may be moved to a UPMC for You participating hospital. You will be moved only when you are strong enough.

Consider UPMC AnywhereCare.* With this service, you can do an e-visit with a UPMC provider straight from your computer, tablet, or phone. Anytime, day or night. And there is no cost for UPMC for You members.

UPMC AnywhereCare is perfect for problems such as a sore throat, cough, runny nose, sinus infection, cold or flu symptoms, back pain, and poison ivy. Simply sign in and describe your symptoms. A provider will get back to you—often within minutes—with a diagnosis and care plan. You can even get a prescription if needed.

Benefits of UPMC AnywhereCare include:

• One more way to access great health care.
• Less serious conditions get taken care of before they become more serious.
• Less time from your day because e-visits take minutes, not hours.
• Peace of mind that you’re always covered when symptoms arise.

Visit UPMC AnywhereCare for more information or to sign up.

*UPMC for You members located in Pennsylvania at the time of the virtual visit may select a UPMC-employed provider or a provider from Online Care Network II, P.C. (OCN), subject to availability and discretion of the provider. During the COVID emergency, members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC. After the COVID emergency ends, UPMC AnywhereCare virtual visits are not covered services when UPMC for You members are traveling outside of Pennsylvania.

Whether you are seeking general health advice or information regarding a specific medical issue or just need quick assistance, UPMC MyHealth 24/7 Nurse Line registered nurses provide prompt and efficient service. After discussing the symptoms with you, the nurse will help you determine what level of care is necessary.

The UPMC MyHealth 24/7 Nurse Line is available 24 hours a day, seven days a week. Just call 1-866-918-1591. TTY users should call 711. Be sure to have your ID card ready.

UPMC nurses who answer calls are licensed to assist members located in Pennsylvania, West Virginia, and Ohio. Members must be located in one of those states when calling the UPMC MyHealth 24/7 Nurse Line. The UPMC MyHealth 24/7 Nurse Line is not a substitute for medical care. If you have an emergency, go to the nearest emergency department, call 911, or call the local ambulance service. Our nurses are not able to answer plan-related and billing questions. Call the Health Care Concierge team for those types of questions.

Behavioral health services include both mental health and substance use disorder services. These services are provided through behavioral health managed care organizations (BH-MCO) that are overseen by the Pennsylvania Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS).

You do not need a referral from your primary care provider (PCP) to get behavioral health services, but your PCP will work with your BH-MCO and behavioral health provider(s) to help you get the care that best meets your needs. You should tell your PCP if you or someone in your family is having a mental health or substance use problem.

You can find the BH-MCO that serves your county here. The BH-MCO can help you find providers that treat mental health and substance use disorders.

You can call your BH-MCO toll-free 24 hours a day, 7 days a week. You can also call the UPMC for You Health Care Concierge team at 1-800-286-4242 to get contact information for your BH-MCO. TTY users should call 711. Help is available Monday, Tuesday, Thursday, and Friday from 7 a.m. to 7 p.m.; Wednesday from 7 a.m. to 8 p.m.; and Saturday from 8 a.m. to 3 p.m.

If you have questions about transportation to behavioral health care appointments, you should contact your BH-MCO.

If you are thinking about suicide, are worried about a friend or loved one, or would like emotional support, call the National Suicide Prevention Lifeline at 1-800-273-8255. Help is available 24/7 across the United States.