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If you are not sure whether a provider is preferred, call UMP Customer Service at 1-888-849-3681 (TRS:711) or call the provider directly. For urgent care facilities, make sure you ask the facility whether a UMP preferred provider is available. These facilities may have a rotating staff that changes frequently.
Note: UMP does not cover most dental services. Search for dental providers through the PEBB Program.
Alert: Because UMP is actively recruiting Applied Behavior Analysis (ABA) Therapy agencies and providers, please call UMP Customer Service 1-888-849-3681 (TRS: 711) for help finding an ABA Therapy provider. They can also help you find providers who can diagnose autism or confirm an autism diagnosis. If a preferred provider is not available in your area, you may request that a case manager contact you to assist with the next steps in seeking coverage.
When you see a preferred provider:
- You pay less: 15 percent of the plan allowed amount for most covered services after you pay your medical deductible.
- You pay nothing for covered preventive care services and covered immunizations.
- You will not have to file a claim if UMP is your primary coverage.
- These providers cannot bill you for charges that exceed the plan's allowed amount (called balance billing).
Alert: Some providers are preferred at one practice location but not another. Please call UMP Customer Service at 1-888-849-3681 (TRS: 711) if you have any questions about the network status of a provider at a specific location.
The plan pays for covered services only when performed by covered provider types working within the scope of their license(s). When a facility charges facility fees, the services must be covered services and within the scope of the facility's license to be covered.
All preferred providers are covered provider types. Click on "Covered provider types" below for a full list.
If you see an out-of-network provider who is not a covered provider type, the plan will not pay for any of the services you received. You will be responsible for all charges. As with all noncovered services, any payments you make to a noncovered provider type will not count toward your medical deductible or medical out-of-pocket limit.
|Provider specialty type code||Provider specialty type name|
|ARNP||Advanced registered nurse practitioner|
|BCBA||Licensed behavior analyst|
|CGC||Licensed genetics counselor|
|CNM||Certified nurse midwife|
|CRNA||Certified registered nurse anesthetist|
|DDS or DMD||Dentist|
|EAMP||East Asian medicine practitioner|
|LCSW||Licensed clinical social worker|
|LMFT||Licensed marriage and family therapist|
|LMHC||Licensed mental health counselor|
|LMP||Licensed massage practitioner|
|PA||Licensed physician assistant/physician assistant certified|
|PhD, PsyD, EdD||Psychologist|
|RN||Licensed registered nurse|
|SLP||Speech language pathologist|
A primary care provider is a physician, nurse practitioner, or physician assistant who helps you receive preventive care such as covered immunizations, well-child visits for your children, cancer screenings (e.g., breast, cervical, prostate) and can help coordinate care for you when you need to see specialists.
You are not required to choose a primary care provider, but doing so may be helpful. Read your certificate of coverage to learn more. To find a primary care provider in your area, use the provider search.
No, you do not need a referral from the plan to see a specialist for most services. However, you will save money by seeing preferred providers, especially for preventive services. See "Why choose a preferred provider?" above for details.