Providers

A network is the facilities, providers, and suppliers your health plan contracts with to provide health care services and ensure the lowest out-of-pocket expenses for you. You’ll save money when you see a network provider and pay more when you see an out-of-network provider. UMP has 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.

Participating provider networks

UMP Achieve 1, UMP Achieve 2, and UMP High Deductible plans have participating provider networks. You pay more when you choose a participating provider instead of a preferred provider, however, participating providers will not balance bill you like out-of-network providers can.

UMP Plus, also known as an accountable care network

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.

There are several reasons why you should choose a 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

A primary care provider (PCP) is a physician, nurse practitioner, or physician assistant who provides, coordinates, and helps you access a range of health care services, such as covered immunizations. A PCP may also help coordinate care for you when you need to see specialists.

You are not required to choose a PCP, however, a PCP may help prevent and treat health care conditions early, promoting your health and well-being.

Specialists

UMP does not require a referral from your PCP to see a specialist for most services. However, some specialists may require a referral before allowing you to schedule an appointment. You may contact the specialist to find out whether they require a referral from your PCP. As with other provider types, you’ll save money by seeing a specialist in your network.

Note: The fact that a provider prescribes or supplies a service or supply does not make it a medically necessary covered service.

DispatchHealth

DispatchHealth delivers mobile urgent care services in the comfort of your own home 7 days a week, 365 days per year.

DispatchHealth is available in Olympia, Seattle, Spokane, Tacoma (8 a.m. to 10 p.m.) and Portland, OR (8 a.m. to 6 p.m.). View DispatchHealth's service area and verify access using a ZIP code.

To request a visit, complete a request on the DispatchHealth website, or call 1-888-908-0553. DispatchHealth will make sure it's safe to treat your urgent but non-life-threatening medical condition at home. View the complete list of the conditions and symptoms they treat.

Virtual therapy can be more comfortable than going in person, and it can also be a faster way to get care. Many behavioral health providers offer virtual appointments. To find providers in your network, register or sign in to your regence.com account and select Get care now, then select Find behavioral health support. You can then select Find a behavioral health provider or In-network virtual care.

When you see a network virtual behavioral health provider, services are paid at the network rate. If you see an out-of-network provider, telemedicine services are paid at the out-of-network rate. See the “Summary of services and payments” section in your plan’s certificate of coverage for more details.

If you are a UMP Plus member, you may see a provider in the state of Washington who is contracted with Regence but does not participate in the UMP Plus core or support networks for services such 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. See Other services paid at the network rate in your UMP Plus certificate of coverage for a complete list of services that fit into this category.

Out-of-network providers cost you the most money. Your plan reimburses out-of-network providers at a lower rate than network providers, and out-of-network providers may balance bill you. This means that the provider may bill you for charges above the allowed amount.

Some providers who work in a network facility may not be network providers. To ensure that you receive the highest benefit level, confirm the network status of the provider and facility before you receive services by visiting the Find a doctor website or by calling UMP Customer Service.

Our plans offer coverage nationally and internationally.

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

• Calling UMP Customer Service
• 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.

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:

• Using the Blue Cross Blue Shield Global® Core provider search (registration is required)
• Calling the Global Core Service Center at 1-800-810-BLUE (2583) or call collect 1-804-673-1177 (24 hours a day, 7 days a week)

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.

Before your trip, call UMP Customer Service to get information about your international coverage. Call the Global Core Service Center at 1-800-810-2583, visit Blue Cross Blue Shield Global® Core, or download their app (for free from the Apple 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.

You may request a travel override to get an extra supply of prescription drugs for extended travel. You may request no more than two travel overrides per calendar year, including all travel within or outside the U.S. Additional conditions apply. To request a travel override, call WSRxS Customer Service at 1-888-361-1611 (TRS: 711). Be sure to fill your extra supply of prescription drugs from a network pharmacy. Search for a network pharmacy or call WSRxS Customer Service.

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

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, or UMP High Deductible, all network 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.

Not sure about the network status of your provider? Use Find a doctor, call UMP Customer Service, or ask the provider.

DispatchHealth is a separate company that provides in-home care services.