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About the Program
Medicare has started an initiative where health care providers who share a common set of goals aimed at improving patient care can work together more effectively. This initiative brings together health care professionals in an Accountable Care Organization (ACO), to work together with Medicare to give you more coordinated care and services.
Our practice is voluntarily taking part in this new initiative by joining Upperline Plus because we think it will help us provide better quality care for our patients.
You are receiving this information and form because your doctor or other health care professional thinks that you might benefit from care coordination and preventive services offered by Upperline Plus.
Upperline Health is offering you additional services through a unique care program called Upperline Plus. Through this program, you are eligible for comprehensive services such as home visits by our care team, 24/7 call with a provider, unlimited telehealth visits, mail-order medications, a dedicated pharmacist and nutritionist, mental health support, among other benefits. All of these services are designed to deliver you more care, more comfort, more communication, and more convenience within a coordinated care team. This form is confirming that our practice would be your main doctor for routine care, which includes the lower extremity care we already provide you. This form does not change or limit any doctor you currently see. We believe this offering will help patients and their families.
You can use this form to confirm that our practice is the main doctor or other health care professional you see or the main place you go for lower extremity routine care, to help determine if Upperline Plus should help coordinate your care. Routine care can include regular care and check-ups you get from a doctor or other health care professional and care for other chronic health problems, such as asthma, diabetes, and hypertension.
Your benefits will NOT change, and you can visit any doctor, other health care professional, or hospital.
Whether or not you complete the attached form or select a doctor or other health care professional through Medicare.gov, you remain eligible to receive the same Medicare benefits and you still have the right to use any doctor, other health care professional, or hospital that accepts Medicare, at any time. If you have questions, feel free to ask your doctor or other health care professional, call Upperline Plus at 855-669-7843, or call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about ACOs. TTY users should call 1-877-486-2048.
Completing this form or selecting a doctor or other health care professional through Medicare.gov is your choice AND you can change your mind.
If you choose to complete this form or select a doctor or other health care professional through Medicare.gov you should do so yourself. No one else should complete this for you.
No one is allowed to attempt to influence your choice to complete this form or select a doctor or other health care professional through Medicare.gov by offering or withholding anything in exchange for you to complete or not complete the form or to make a selection online. If you feel pressured to sign or not sign this form or to make a selection online, please call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Please call 855-669-7843 or update your online selection if you change your mind later about whether you consider our practice to be the main doctor or other health care professional you see or the main place you go for routine care.
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