Using Network Providers
Why You Should Use Network Providers
Use Your UMP ID Card
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:
- 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 UMP's payment and coverage rules.
To find a network provider, see our online provider directory, or call UMP Customer Service at 1-800-762-6004.
Avoid Using Non-Network Providers
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.
Important: This information is effective through Dec. 31, 2009. See the changes to coinsurance, medical deductible, and out-of-pocket limit for 2010.
| 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). | ||
If You Don't Have Access to a Network Provider
Important: This information is effective through Dec. 31, 2009. See the changes to coinsurance, medical deductible, and out-of-pocket limit for 2010.
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.
Medicare Retirees Are Not Limited to UMP Network Providers
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.
Confirm That Hospital-Based Providers Are in the UMP Network
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.
