Providers

Learn about our networks and why you should choose preferred or network providers. Also, find out about primary care providers, specialists, avoiding out-of-network costs, and how you’re covered while traveling in the U.S. and abroad.

 Why networks matter

A network is the facilities, providers, and suppliers your health plan contracts with to provide health care services. You’ll save money when you see a network provider and pay more to see an out-of-network provider. UMP has two different kinds of networks:

Preferred provider networks

UMP Achieve 1, UMP Achieve 2, and UMP High Deductible plans have preferred provider networks. You get the most from your plan when you choose a preferred provider.

Find a preferred provider.

Accountable care networks

UMP Plus has two accountable care networks: Puget Sound High Value Network and UW Medicine Accountable Care Network. The amount you pay for services will depend on the network status of the provider.

Learn more about UMP Plus networks.

 Choosing a preferred or network provider

There are several reasons why you should choose a preferred or network provider:

  • You pay less.
  • You pay nothing for covered preventive care and immunizations.
  • You don’t have to file a claim.
  • These providers can’t bill you for charges that exceed the allowed amount (called balance billing).
 Primary care providers and specialists

Primary care providers

A primary care provider is a physician, nurse practitioner, naturopathic physician, or physician assistant who provides, coordinates, or helps members access a range of health care services. You don’t have to choose a primary care provider, but it may be helpful.

Specialists

You don’t need a referral to see a specialist for most services. As with other types of providers, you’ll save money by seeing preferred or network specialists.

Note: The fact that a service or supply is prescribed or supplied by a provider does not make it a medically necessary covered service.

  Other providers

You may see a provider who is contracted with Regence but does not participate in the UMP Plus core or support networks, for such services as Applied Behavior Analysis (ABA) Therapy, family planning services, and transgender health services.

If you need help finding providers who perform these services, call UMP Customer Service at 1 (888) 849-3681 (TRS: 711). See "Other providers" in your certificate of coverage for a complete list of services that fit into this category.

 Avoiding out-of-network costs

Some hospital-based providers (such as anesthesiologists and emergency room doctors), who work in a preferred or network hospital or other facility, may not be preferred or network providers.

If a participating or out-of-network provider bills separately from the hospital, you will pay a percentage of the allowed amount. For out-of-network providers, you may also be balance billed by the provider.

Networks include providers, hospitals, and other facilities. To ensure that you receive the highest benefit level, confirm whether the provider and facility are in your plan’s network.

Call UMP Customer Service to find out if a provider, hospital, or other facility is in your plan’s network. It may save you money!

 Travel coverage

Our plans offer coverage nationally and internationally.

Traveling in the United States

When you're traveling in the U.S. and need care, you can find a preferred or network provider by:

  • Calling UMP Customer Service at 1 (800) 628-3481 (TRS: 711)
  • Signing in to your Regence account and using Find a doctor.

If you have a UMP Plus plan, see your certificate of coverage to find out how care is covered outside the service area.

Traveling outside the U.S.

When traveling internationally, UMP members are covered by Blue Cross Blue Shield Global Core, which provides access to covered providers worldwide. You can find a contracted provider outside the U.S. by:

If you are admitted to a hospital outside the U.S., you need to notify the plan by contacting Global Core Service Center. If you receive inpatient care at a contracted Global Care hospital, you’ll pay your normal out-of-pocket costs, such as deductible, copayment, or coinsurance. Contracted hospitals will submit a claim for you, and you’ll pay the provider after the plan processes the claim.

If you receive outpatient care or services at a non-contracted hospital, you’ll need to pay the provider or hospital at the time of service. After paying, you may ask the non-contracted hospital if they will submit a claim for you. Otherwise, you should complete an International Claim Form and send it to the Blue Cross Blue Shield Global Core Service Center. Your claim will be reimbursed at the out-of-network rate for covered services. The provider may balance bill you for all charges above the allowed amount.

International travel tips

Before your trip, call UMP Customer Service to get information about your international coverage. Call the Global Core Service Center, visit Blue Cross Blue Shield Global Core or download their app (for free from the iTunes Store or on Google Play ) to see if there's a network hospital at your destination. Be sure to present your UMP member ID card when you get care.

More about travel coverage

For more information, UMP Achieve 1, UMP Achieve 2, and UMP High Deductible members should read the "Services received outside the U.S." section and UMP Plus members should read the "Services received outside the service area" section in your plan's certificate of coverage.

  Covered providers

The plan pays for covered services only when medically necessary and performed by covered provider types working within the scope of their license(s). If you have UMP Achieve 1, UMP Achieve 2, and UMP High Deductible, all preferred providers are covered provider types.

If you have UMP Plus, all providers in the Core network and Support network are covered provider types. If you see an out-of-network provider who is not a covered provider type, the plan will not pay for any of the services received, and you will be responsible for all charges. Payments made to a non-covered provider type will not count toward your medical deductible or medical out-of-pocket limit.

View the complete list of covered provider types.

 Need help?

Not sure whether a provider is preferred or in your network? Use Find a doctor, call UMP Customer Service, or ask the provider.