Whenever you see a provider or fill a prescription, make sure you show your UMP ID card. Pharmacies need this information to charge you the right amount. And it's a good idea to make sure that your provider has the right insurance information at each visit, to make sure it's billed correctly.
There are many advantages to using UMP network providers whenever possible, including:
To find a network provider, see our online provider directory, or call UMP Customer Service at 1-800-762-6004.
Using non-network providers will cost you more, often much more. See the table below for an example of how much more non-network services may cost you. In addition, since non-network providers do not have to follow UMP rules, you may end up paying the entire bill for excluded services. 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 annual medical deductible.
| Network Provider | Non-network Provider | |
|---|---|---|
| Provider's Billed Charge | $150 | $150 |
| UMP Allowed Amount | $100 | $100 |
| Provider Discount | -$50 | 0 |
| Total Charge That Must Be Paid | $100 | $150 |
| What UMP Pays (% of Allowed Amount) |
$90 (90% of $100) | $60 (60% of $100) |
| What You Pay (Balance) |
$10 | $90* |
| * You pay 40% of the UMP allowed amount ($40) plus the amount the provider charged over the allowed amount ($50). | ||
In certain circumstances, UMP may pay for services at the out-of-area rate, which is 80% of the UMP allowed amount; however, you still owe the provider any amount that is above the UMP allowed amount in addition to your 20% coinsurance.
If you are enrolled in Medicare and receive services from a provider who accepts Medicare assignment, the services will be paid at the network level. For more information on how UMP and Medicare work, see our Frequently Asked Questions about Medicare .
Physicians such as anesthesiologists and emergency room doctors may not be network providers, even if they work at a UMP network hospital. Check our online provider directory or call UMP Customer Service at 1-800-762-6004 before scheduling surgery to make sure your providers are in the UMP network.