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 what UMP covers that Medicare doesn't to see which services apply. Use the Provider Search or call 1-888-849-3681 (TRS: 711) 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. See Use network pharmacies that bill Medicare Part B directly for more information.
You do not receive higher benefits when you see a preferred provider for services covered by Medicare. However, you should see a provider who accepts Medicare. See the opt-out providers section below to learn why this is important.
When services are covered by Medicare, you must see providers who accept Medicare for the services to be covered by Medicare and UMP Classic. If your provider is not contracted with Medicare or has chosen to “opt out” of participating in Medicare, UMP Classic will not cover services by that provider, even if the provider is in the Regence or Blue Card network (preferred) for UMP Classic 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 and Medicare 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 have met both your Medicare and UMP Classic deductibles, you will not pay anything for most claims.
If you have not received any paperwork on a health care service within three months, call your provider’s billing office and ask if they have sent the claim. Neither Medicare nor UMP Classic can process a claim they have not received. While you are welcome to call UMP Classic and ask, if we have not received the claim, we will not 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 usually pays less than its normal benefit when it is a secondary payer to Medicare.
The difference between what UMP Classic pays as the secondary plan and what UMP Classic would have paid had it been the primary payer, is your Coordination of Benefits (COB) savings.
UMP Classic keeps track of how much you have paid out of pocket during the year. If your Medicare coverage generates COB savings, we may send you a “COB savings check” to pay you back for the out-of-pocket expenses you paid earlier in the year. UMP Classic does not reimburse you for more than you paid out of pocket. See the “How do UMP Classic and Medicare work together?” section in your certificate of coverage for examples.
UMP Customer Service
Online: Your Regence account
Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)