UMP Plus provider information

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What's a UMP Plus network provider?

Network providers are in either the core or support networks. With these providers, most covered services are paid at 85 percent and you will not be balance billed.

  • Core network—contains primary care providers, specialty providers, ancillary providers, and facilities (such as hospitals and clinics) contracted with your UMP Plus network.*
  • Support network—contains certain providers contracted with Regence but not in your UMP Plus network. All of the providers in this network are ancillary.

An out-of-network provider is not in the core or support networks. If you see an out-of-network provider for covered services, you will pay 50 percent of the allowed amount, and the provider may balance bill you. 

Alert! Some Regence providers are considered out-of-network. If you see a preferred or participating provider with Regence who is not in the core or support network, they are considered out-of-network.

*UMP Plus has two separate networks: Puget Sound High Value Network (PSHVN) and UW Medicine Accountable Care Network (UW Medicine ACN). To get the best use of your benefits, use providers in the network you enrolled in. 

Network provider types

You have access to the following provider types through the core and support networks.

  • Network primary care providers such as family practice, adult medicine, or women’s health.
  • Network specialty providers such as cardiologists, dermatologists, or allergists.
  • Ancillary providers such as chiropractors, mental health providers, or physical therapists.
  • Network facilities such as hospitals or clinics.

When you see a network provider at a facility (such as a hospital), check that the facility is also in the network.

Tip: Usually, routine health care services such as annual physical exams and care for minor illnesses (like the flu or an ear infection) are performed by a primary care provider.

Primary care providers (PCPs) provide and coordinate a range of health care services for you. A PCP must be a doctor, nurse practitioner, or physician’s assistant in the core network (or a naturopath in the support network) who specializes in one of the following:

  • Adult medicine
  • Family practice
  • General practice
  • Geriatrics
  • Internal medicine
  • Obstetrics, Gynecology, or OB/GYN
  • Pediatrics (for patients under age 18)
  • Preventive medicine
  • Women’s health

When you see a PCP for primary care services, you pay nothing for office visits. Related services, such as x-rays or labs, that you receive during the visit may be subject to your medical deductible and coinsurance. For most other covered services with a PCP, you will pay 15 percent of the allowed amount after meeting your deductible.

If you see an out-of-network PCP, you pay 50 percent of the allowed amount and the provider may balance bill you.

A specialty provider is in the core network and specializes in a certain area of care, such as cardiology. UMP Plus offers over 90 types of specialty providers. To find the complete list, visit your network's provider search (PSHVN and UW Medicine ACN) and click on the "Specialty" drop-down menu.

Here are some examples of specialty providers:

  • Allergists
  • Cardiologists
  • Dermatologists
  • Endocrinologists
  • Gastroenterologists
  • Neurologists
  • Urologists

For most covered services with specialty providers, you pay 15 percent of the allowed amount after meeting your medical deductible.

If you see an out-of-network specialist, you pay 50 percent of the allowed amount, and the provider may balance bill you.

An ancillary provider is one of the provider or facility types listed below. Ancillary providers are available in both the core and support networks.

Ancillary facilities Ancillary providers
  • Birth centers
  • Chemical dependency facilities
  • Dialysis
  • Durable medical equipment suppliers
  • Hearing aid dispensary
  • Home health providers
  • Hospice
  • Laboratories (lab testing)
  • Mental health facilities
  • Rehabilitation, inpatient
  • Skilled nursing facility
  • Urgent care
  • Acupuncturists
  • Anesthesiologists
  • Audiologists
  • Chemical dependency providers
  • Chiropractors
  • Massage therapists, licensed
  • Maxillofacial surgeons
  • Mental (behavioral) health providers (including M.D.s, such as psychiatrists)
  • Midwives, licensed
  • Occupational therapists
  • Pathologists
  • Physical therapists
  • Registered dieticians
  • Speech therapists

For ancillary providers in the core or support network, you pay 15 percent of the allowed amount for covered services.

If you see an out-of-network ancillary provider, you pay 50 percent of the allowed amount and the provider may balance bill you.

Clinics and other outpatient facilities

At clinics in the core network and other outpatient facilities, you pay 15 percent of the allowed amount for covered services. When you see a network provider at a facility (such as a clinic), confirm that the facility is also a network provider.

Urgent care clinics: When you see a provider at an urgent care clinic in the core or support networks, you pay 15 percent of the allowed amount.

Hospitals

Inpatient services: At hospitals in the core network, you pay an inpatient copay of $200 per day, up to an annual maximum of $600. You pay 15 percent of the allowed amount for professional services.

Outpatient services: At hospitals in the core network, you pay 15 percent of the allowed amount. You may be balance billed at out-of-network hospitals.

You can find more information on the summary of benefits webpage under "Emergency room" or “Hospital services.”

Alert! Non-medical emergencies treated at an out-of-network emergency room may not be covered. If the plan does pay, it will be at the out-of-network rate.

Who can I see for emergency or urgent care?

Emergency care

For a medical emergency, you can see any provider, regardless of network status, and receive the network rate. However, if you see an out-of-network provider, they may balance bill you.

You may also have an emergency room copayment. Learn more about emergency room visits on the summary of benefits webpage under “Emergency room.”

Urgent care

You may visit urgent care clinics in the core or support network, and you will pay 15 percent of the allowed amount for most covered services after meeting your deductible.

Who can I see for specific services, like bariatric surgery?

For specific services like bariatric surgery or transgender services, you may see any provider contracted with Regence - even if that provider is not in the core or support network - and receive the network rate. For most covered services, this means you will pay 15 percent of the allowed amount after meeting your deductible.

See your plan’s certificate of coverage (PSHVN or UW Medicine ACN) for a full list of services that fit into this category.

What is a covered provider type?

UMP Plus pays for covered services only when performed by a covered provider type working within the scope of their licenses. All providers in the core and support networks are covered provider types. 

Click on "Covered provider types" below to see the full list. For most services, the amount you pay depends on the network status of the provider.

If you see an out-of-network provider that is a noncovered provider type, the plan will not pay for any of the services received. You will be responsible for all charges. Payments for those charges 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
AUD Audiologist
CCCA Cert of Clinical Competence/Audiology
CGC Certified Genetics Counselor
CN Certified Nutritionist
CNFA Certified Nurse First Assist
CNM Certified Nurse Midwife
CRNA Certified Registered Nurse Anesthetist
CRNFA Certified Registered Nurse First Assist
DC Doctor of Chiropractic
DDS Doctor of Dental Surgery
DMD Doctor of Dental Medicine
DO Doctor of Osteopathy
DPM Doctor of Podiatric Medicine
EAMP East Asian Medicine Practitioner
LAC Licensed Acupuncturist
LCPC Licensed Clinical Professional Counselor
LCSW Licensed Clinical Social Worker
LICSW Licensed Independent Clinical Social Worker
LM Licensed Midwife
LMFT Licensed Marriage/Family Therapist
LMHC Licensed Mental Health Counselor
LMT Licensed Massage Therapist
LMSW Licensed Master Social Worker
MD Doctor of Medicine
MSW Masters in Social Work
ND Doctor of Naturopathy
NP Nurse Practitioner
OD Optometrist
OTR Registered Occupational Therapist
PA Physician Assistant
PAC Physician Assistant Certified
PHD Psychologist
PMHNP Psych. Mental Health Nurse Practitioner
PSYD Doctorate in Psychology
RD Registered Dietician
RNFA Registered Nurse First Assist
RNSA Registered Nurse Surgical Assistant
RPT Registered Physical Therapist
SLP Speech Language Pathologist

Contact

UMP Customer Service
Phone: 1-888-849-3681
TRS: 711 
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific time (PT)

Puget Sound High Value Network
Phone: 1-855-776-9503
Business hours: Monday-Friday 6:30 a.m. to 8 p.m. and Saturday 7 a.m. to 6 p.m. PT

UW Medicine Accountable Care Network
Phone: 1-855-520-9500
TRS: 711
Business hours: Monday-Friday 6:30 a.m. to 8 p.m., Saturday 7 a.m. to 8 p.m.,  and Sunday 8 a.m. to 5 p.m. PT