UMP Plus provider information
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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
- 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:
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|
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.
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.
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 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.
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.
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|
|CCCA||Cert of Clinical Competence/Audiology|
|CGC||Certified Genetics Counselor|
|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|
|LCPC||Licensed Clinical Professional Counselor|
|LCSW||Licensed Clinical Social Worker|
|LICSW||Licensed Independent Clinical Social Worker|
|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|
|OTR||Registered Occupational Therapist|
|PAC||Physician Assistant Certified|
|PMHNP||Psych. Mental Health Nurse Practitioner|
|PSYD||Doctorate in Psychology|
|RNFA||Registered Nurse First Assist|
|RNSA||Registered Nurse Surgical Assistant|
|RPT||Registered Physical Therapist|
|SLP||Speech Language Pathologist|
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