Seeing providers and Medicare
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Alert! Preferred providers do not necessarily accept Medicare—you should always ask.
You receive higher benefits when you see a preferred provider for the following types of service:
- Services covered by UMP Classic but not by Medicare: (Exception: See massage therapy below.) See a list of services that apply. Use the Provider Search or call 1-888-849-3681 to find a preferred provider.
- Massage therapy: UMP Classic pays for massage therapy services only when the provider is preferred.
- Prescription drugs: You must also choose pharmacies that participate in and can bill Medicare Part B directly because Medicare Part B covers a few drugs.
You do not receive higher benefits when you see a preferred provider for services covered by Medicare. You should see a provider who accepts Medicare; see below for more about why this is important.
When Medicare is your primary coverage and you receive services that are covered by Medicare, you must see providers who accept Medicare to get the services covered by Medicare and UMP. If your provider has chosen to “opt out” of participating in Medicare, UMP will not cover services by that provider, even if the provider is in the Regence or BlueCard network for UMP members.
Providers that "opt out" of Medicare are supposed to have you sign a “private contract” before providing services, but you are responsible for all costs even if you did not sign a contract.
Most of the time, you pay only after both Medicare and UMP Classic have processed your claim.
Here’s how it typically works:
- Your provider bills Medicare.
- Medicare processes the claim, and sends you an Explanation of Medicare Benefits (EOMB). The EOMB tells you how much Medicare paid on your claim.
- Medicare then sends the claim to UMP Classic for processing. You do not need to submit a claim form or other paperwork to UMP Classic.
- UMP Classic processes the claim and sends you an Explanation of Benefits (EOB). The EOB tells you how much UMP Classic paid, plus how much you owe the provider.
- You receive a bill from your provider for any remaining amount due. To confirm that the provider has credited your account with both Medicare and UMP Classic payments:
- Note the allowed amount on the Medicare EOMB.
- Subtract both Medicare’s and UMP Classic’s payments from that amount; this should match the bill from your provider.
- You pay your provider the amount due, if any. After you’ve met both your Medicare and UMP Classic deductibles, you won’t pay anything for most claims.
If you haven’t received any paperwork on a health care service within three months, call your provider’s billing office and ask if they’ve sent the claim. Neither Medicare nor UMP Classic can process a claim they haven’t received. While you are welcome to call UMP Classic and ask, if we haven’t received the claim, we won’t have any record of the service.
At the beginning of the year, you must first satisfy your Medicare and UMP Classic deductibles. Once you have satisfied these deductibles in full and receive more health care services during the year, UMP Classic (your secondary plan) usually pays less than its normal benefit.
The difference between what UMP Classic pays as the secondary plan and what UMP Classic would have paid had it been the first payer ("primary payer"), is your Coordination of Benefits savings, or "COB savings."
UMP Classic keeps track of how much you’ve paid out of pocket during the year. If your Medicare coverage generates COB savings for UMP Classic, we may send you a “COB savings check” to pay you back for the out-of-pocket expenses you paid to providers earlier in the year for covered services.
UMP Classic does not reimburse you for more than you paid out of pocket. See an example in your Certificate of Coverage.