Preferred vs. out-of-network providers
On this page
Here are some advantages to using preferred providers:
- You pay less, often much less.
- Preventive care services (including immunizations) are covered in full.
- You won't have to file a claim if UMP is your primary coverage.
- The provider won't balance bill you.
Alert! Some providers are preferred at one location but not another. If you see a provider at an out-of-network location, services will be covered as out-of-network even if he or she is preferred somewhere else. If you see a provider at a new or different location, make sure he or she is a preferred provider there as well.
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.
Some hospital-based physicians (such as anesthesiologists and emergency room doctors) who work in a preferred hospital may not be preferred providers.
If a participating or out-of-network provider bills separately from a hospital, you will pay 40 percent of the allowed amount. Out-of-network providers may also balance bill you.
Call UMP Customer Service at 1-888-849-3681 to see the network status of anesthesiologists and emergency room doctors in Washington State hospitals.
If you are enrolled in Medicare and receive services from a provider who accepts Medicare, the services will be paid at the network rate. Learn more about how UMP and Medicare work together in the For Medicare retirees section of the website.
Using out-of-network providers will cost you more.
- You pay 40 percent of the allowed amount after you pay your deductible, and you may be balance billed. This 40 percent coinsurance does not count toward your out-of-pocket limit.
- You may have to pay for the service upfront and submit the claim yourself.
- The provider may not request preauthorization for services that require it. As a result, payment may be delayed or denied.
- The provider may not be familiar with UMP prescription drug guidelines. You may be prescribed drugs that cost more or that aren’t covered by the plan.
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. See your certificate of coverage to compare the costs of using preferred and out-of-network providers for UMP Classic or UMP CDHP.