Preferred vs. out-of-network providers

UMP Classic and UMP CDHP: Why you should use preferred providers

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.

Tip: Use 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.

Note: If you don't have access to a preferred provider, your provider may be able to submit a network waiver request, which allows the plan to pay for services provided by an out-of-network provider at the network rate. See your UMP Classic or UMP CDHP certificate of coverage for details.

Confirm that hospital-based providers are preferred

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.

Medicare retirees are not limited to preferred providers

If you are enrolled in Medicare and receive services from a provider who accepts Medicare, the services will be paid at the preferred level. Learn more about how UMP and Medicare work together in the For Medicare retirees section of the website.

Avoid using out-of-network providers

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 Participating provider Out-of-network provider

Provider's billed charge

$150

$150

$150

Allowed amount

$100

$100

$100

Provider discount

-$50

-$50

0

Total charge to be paid

$100

$100

$150

What your plan pays
(% of allowed amount)

$85 (85 percent of $100)

$60 (60 percent of $100)

$60 (60 percent of $100)

What you pay
(balance)

Total: $15

Total: $40

Member coinsurance (40 percent of allowed): $40

Difference between allowed and provider's billed charge: $50

Total: $90*

*This amount does not apply to your out-of-pocket limit.