Using Network Providers

Why You Should Use Network Providers

Use Your Member ID Card

Make sure you show your member ID card whenever you see a provider or fill a prescription. Pharmacies and providers need this information to charge you the right amount and bill your plan correctly.

Here are some of the many advantages to using network providers:

  • You pay less for your care, often much less.
  • Services covered under the preventive care benefit are free when you see a network provider.
  • You don't have to file a claim; the provider does it for you.
  • The providers agree to follow your plan's payment and coverage rules.

To find a network provider, use the Provider Search tool, or call Customer Service at 1-888-849-3681.

Avoid Using Non-Network Providers

Using non-network providers will cost you more, often much more (see table below). Even if you are referred to a non-network provider by a network provider, claims will be paid at the non-network rate.

This example assumes you've met your medical deductible.

  Network Provider Non-network Provider
Provider's Billed Charge $150 $150
Allowed Amount $100 $100
Provider Discount -$50 0
Total Charge That Must Be Paid $100 $150
What Your Plan Pays
(% of Allowed Amount) 		$85 (85% of $100) $60 (60% of $100)
What You Pay
(Balance)		 $15

Member coinsurance (40% of plan allowed): $40

Difference between allowed and provider's billed charge: $501

Total you pay: $902

1 This amount does not apply to your medical deductible.
2 This amount does not apply to your medical out-of-pocket limit.

Medicare Retirees Are Not Limited to Network Providers

If you are enrolled in Medicare and receive services from a provider who accepts Medicare, the services will be paid at the network level. For more information on how UMP and Medicare work together, see our Frequently Asked Questions about Medicare.

Confirm That Hospital-Based Providers Are In-Network

Physicians such as anesthesiologists and emergency room doctors may not be network providers, even if they work at a network hospital. Check our Provider Search tool or call Customer Service at 1-888-849-3681 before scheduling surgery to make sure your providers are in-network.