Preferred vs. out-of-network providers
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Here are some of the many advantages to using preferred providers:
- You pay less for your care, often much less.
- Services covered under the preventive care benefit are free when you see a preferred provider.
- You don't have to file a claim; the provider does it for you.
- The providers agree to follow your plan's payment and coverage rules.
Make sure you show your member ID card whenever you see a provider or fill a prescription. Pharmacies and providers need this information to charge you the right amount and bill your plan correctly.
Physicians such as anesthesiologists and emergency room doctors may not be preferred providers, even if they work at a preferred hospital. Check our Provider Search tool or call Customer Service at 1-888-849-3681 before scheduling surgery to make sure your providers are preferred.
If you are enrolled in Medicare and receive services from a provider who accepts Medicare, the services will be paid at the preferred level. For more information on how UMP and Medicare work together, see our Frequently Asked Questions about Medicare.
Using out-of-network providers will cost you more, often much more (see table below). Even if you are referred to an out-of-network provider by a preferred provider, claims will be paid at the out-of-network rate.
This example assumes you've met your deductible for UMP CDHP or medical deductible for UMP Classic.
|Preferred provider||Out-of-network provider|
|Provider's billed charge||$150||$150|
|Total charge that must be paid||$100||$150|
What your plan pays
(% of allowed amount)
|$85 (85% of $100)||$60 (60% of $100)|
What you pay
Member coinsurance (40% of allowed): $40
Difference between allowed and provider's billed charge: $50
Total you pay: $90*
* This amount does not apply to your out-of-pocket limit.