UPMC for You — How to locate and use the customer service number

Executive summary

UPMC for You is UPMC Health Plan’s Medicaid-managed care product and has a dedicated Member Services line for plan questions, prior authorizations, claims, ID cards, pharmacy coverage and appeals. The single most reliable source for the correct customer service telephone number for your plan and county is your UPMC for You member ID card and the official UPMC Health Plan website (upmchealthplan.com). If you need an immediate corporate contact, UPMC’s main switchboard in Pittsburgh is 412-647-7000 and the health plan’s site is https://www.upmchealthplan.com.

This guide explains where to find the correct Member Services number quickly, what to expect when you call, how to prepare so calls resolve issues faster, and escalation steps — including state resources — if you need an appeal or external help. Information below is written to be practical and immediately usable.

Where to find the correct customer service number

The fastest and most reliable place to locate the UPMC for You Member Services phone number is your member ID card. The card is printed with a toll‑free Member Services number and a TTY/relay contact for people with hearing or speech impairments. If you have lost the card, log in to your secure account at the health plan website (upmchealthplan.com) and view the digital ID card — Member Services is shown there as well.

If you cannot access the member portal, go to the UPMC Health Plan site and navigate to the UPMC for You product page. The site lists phone numbers for Member Services, case management, pharmacy, behavioral health, and language assistance. For accessibility, use TTY 711 for relay services (standard in the U.S.) and ask for interpreter services in your preferred language when you call.

Typical hours and nurse/after‑hours options

Member Services hours for managed Medicaid plans are commonly business hours (for example, Monday–Friday, roughly 8:00 a.m.–5:00 p.m. local time), but UPMC and similar plans also provide a 24/7 nurse advice line for urgent clinical questions and after‑hours care guidance. If your need is clinical and not administrative, ask to be connected to the nurse line right away — that line is staffed 24 hours and can advise on whether you need urgent care, urgent behavioral-health support, or routine follow‑up.

When you call, request the department appropriate to your issue: Member Services for eligibility and ID cards; Claims for billing questions; Pharmacy (or “PBM”) for prescription coverage and prior authorization; Behavioral Health for mental health or substance-use services. Saying the exact department reduces transfers and call time.

What to have ready before you call

Being prepared reduces call time and improves outcomes. Have your UPMC for You member ID number, the primary care provider (PCP) name, dates of service, claim numbers (if applicable), and any letters or authorization notices in front of you. If your question is about a denied claim or medication, have the provider’s name, NPI (provider tax ID), and the drug’s name, dosage and NDC code (found on pharmacy receipts) available.

• Essential items to have: member ID number, DOB, provider name and NPI, dates of service, claim or prescription receipts, authorization or denial letters, and a phone number where you can be called back.
• If you need language assistance: note your preferred language and that you require an interpreter. If you are deaf/hard-of-hearing: indicate TTY 711 and request materials in accessible formats.

Document the call: write down the agent’s name, the date and time, the reference or confirmation number, and the resolution or next steps promised. Ask for a case or confirmation number at the end of the call — this is essential if you later need to escalate.

Common reasons members call and what to expect

Members most frequently call Member Services for: eligibility/coverage questions, replacement ID cards, claims status, prior authorization status, pharmacy coverage, behavioral health referrals, transportation for non-emergent medical trips, and grievance/appeal initiation. The agent will verify identity, look up the member record, and either resolve the question or open a case and provide a target resolution time and case number.

For prior authorizations and appeals: federal/state rules generally require standard appeal decisions within about 30 calendar days and expedited reviews in 72 hours when the urgency threatens health. If a claim or authorization is denied, ask for a written explanation of benefits (EOB) and the formal appeal process including timelines and where to send supporting documentation.

Escalation and external resources

If Member Services cannot solve the issue, there are formal escalation channels: file an internal grievance with UPMC for You (ask the agent to initiate it) and, if needed, request an external fair hearing through the Pennsylvania Department of Human Services (DHS). DHS maintains administrative appeal and hearing procedures for Medicaid managed care disputes; visit the DHS website (https://www.dhs.pa.gov) for up‑to‑date forms and phone contacts.

• UPMC corporate switchboard (for general corporate inquiries): 412-647-7000. Official UPMC Health Plan site for product and Member Services info: https://www.upmchealthplan.com.
• State resources: Pennsylvania Department of Human Services (DHS) — https://www.dhs.pa.gov — for appeals/fair hearings and Ombudsman contacts. Use TTY 711 for relay when needed.

Keep records of all steps: the Member Services confirmation number, grievance filing date, and any caseworker names at DHS. These records are crucial if you later submit documentation for a state review or an external appeal.

Practical tips and sample call script

When you call, be concise and organized. Start with your member ID and the purpose of your call, then state the outcome you want (e.g., “I need a replacement ID card mailed today” or “I want an expedited review for denied authorization”). Request timelines and a reference number. If the agent says they will call you back, ask for the callback number and whether the call will show as a local or toll‑free number on your phone.

Sample opening: “Hello, my name is [First Last], UPMC for You member ID [000000000]. I’m calling about a denied prior authorization for [service/drug] on [date]. Please verify my eligibility, locate the denial, and tell me the steps to start an expedited appeal. Can you give me a case number and expected resolution time?” This directs the agent to the right workflow immediately.

Is UPMC insurance the same as UPMC for You?

The UPMC Insurance Services Division—which includes UPMC Health Plan, Workpartners, UPMC for Life, UPMC for You, UPMC for Kids, UPMC Community HealthChoices, and Community Care Behavioral Health—offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee …

What is the phone number for UPMC for You?

If you have questions about your benefits, call the UPMC for You Health Care Concierge team at 1-800-286-4242 (TTY 711).

Does UPMC for You cover Ozempic?

An AI Overview is not available for this searchCan’t generate an AI overview right now. Try again later.AI Overview Yes, UPMC for You covers Ozempic but requires prior authorization and has quantity limits. The medication is a covered benefit, but it falls under a Tier 2 copayment, and out-of-pocket costs for those with high-deductible plans will be their responsibility until the deductible is met.  Key details about UPMC for You coverage: 

• Coverage: Ozempic is a covered medication.
• Authorization: You must obtain prior authorization.
• Limits: Quantity limits apply to Ozempic.
• Cost: It’s a Tier 2 copay, but high-deductible plan members may pay the full cost until their deductible is satisfied.

Next steps:

1. 1. Contact your provider: Discuss the coverage requirements with your medical provider to ensure it’s the best option for your situation. 
2. 2. Check your plan details: Visit UPMC Health Plan’s search tool or contact UPMC directly to confirm specific coverage details for your plan. 

AI responses may include mistakes. For financial advice, consult a professional. Learn moreUPMC Health Plan MarketplaceUPMC Health Plan MarketplaceDrug & Alcohol Rehabs That Accept UPMC | Check Your Coverage NowSep 6, 2024 — It’s crucial for members to review their plan details or contact UPMC Health Plan directly for precise information rega…The Recovery Village Drug and Alcohol Rehab(function(){
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Is UPMC for u Medicaid?

An AI Overview is not available for this searchCan’t generate an AI overview right now. Try again later.AI Overview Yes, UPMC for You is a Medicaid plan (also known as Medical Assistance in Pennsylvania) offered by UPMC Health Plan, providing health benefits and services to eligible individuals and families in Pennsylvania. UPMC for You serves as a Managed Care Organization (MCO) that coordinates care, including medical, vision, and dental services, for its members.  What UPMC for You is:

• A Medicaid/Medical Assistance managed care plan in Pennsylvania. 
• A plan that helps eligible members access primary care providers, hospitals, pharmacies, and other care providers. 
• A provider of various health services, including medical, maternity, dental, and vision care. 

Key details about UPMC for You:

• State Program: It is a state-licensed managed care organization in Pennsylvania. 
• Services: The plan offers access to a network of doctors, hospitals, and pharmacies, as well as wellness and prevention resources. 
• Member Benefits: UPMC for You helps its members find a primary care provider (PCP) and provides access to various benefits like prescription drugs. 

AI responses may include mistakes. For financial advice, consult a professional. Learn moreMedicaid and Medical Assistance Plans | UPMC for YouUPMC for YouLearn About UPMC for YouWhat’s Covered. As part of your benefits, UPMC for You helps you find a primary care provider (PCP) who can get to know you and yo…UPMC for You(function(){
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How do I speak to Medicaid customer service?

★ Department of Health Care Services

1. California State Contacts.
2. Eligibility.
3. Enrollment.
4. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

How do I contact UPMC directly?

If you are a current user and you need assistance, please e-mail MyUPMC at [email protected], or call our support line at 1-866-884-8579. To sign up for MyUPMC, visit MyUPMC.com or download the MyUPMC app in the App Store for iOS or on Google Play for Android.