Providers - SEBB

This page contains benefit information for 2021. For 2022 open enrollment information visit the UMP SEBB Open Enrollment web page.

Providers

Learn about our networks and why you should choose network providers. Network providers for UMP Achieve 1, UMP Achieve 2, and UMP High Deductible are preferred and participating providers. For UMP Plus, network providers are core and support network providers. For more information about provider types, read your plan’s certificate of coverage.

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 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, but 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.

 Choosing a network provider

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 and specialists

Primary care providers

A primary care provider (PCP) 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

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.

 Mobile providers

DispatchHealth

DispatchHealth serves as a mobile urgent care service that provides care in the home setting for complex injuries and illnesses. View the complete list of the conditions and symptoms they treat. UMP members have access to DispatchHealth in:

  • Idaho (Boise area)
  • Oregon (Portland area)
  • Washington (Seattle, Tacoma, and Olympia areas)

View DispatchHealth’s service area and verify access using a ZIP code.
Note: The program may not apply to all UMP Plus plans.

You can request a visit on the DispatchHealth website or call 1 (888) 908-0553 seven days a week from 8 a.m. to 8 p.m.

Heal

Heal provides primary and urgent care home visits by a physician and laboratory technician.

Heal is currently available to UMP members (except UMP Plus) in the greater Seattle, Washington, area only.

Members can make appointments on the Heal website seven days a week, 365 days a year, from 8 a.m. to 8 p.m.

 Behavioral health providers

Quartet is a program that works alongside your primary care provider to find a specialist to fit your needs. Quartet’s care navigation team matches members to in-person and telemedicine behavioral health providers who are in the plan’s network, have availability, and offer an array of behavioral health services, including mental health counseling, substance use disorder, and psychiatry services.

Quartet does the legwork to match you to the right behavioral health care, so you can spend less time looking for care, and start feeling better instead. Whether it’s help with appointments or understanding your care options, Quartet’s Care Navigators are there to help you along your care journey.

There is no cost to participate in the program. If you see a network provider, your copay, coinsurance, or deductible may apply. Get started by visiting Quartet’s website or by calling Quartet’s Care Navigation Team at (206) 401-0050.

Note: Quartet is only available to UMP members who reside and are seeking care in Washington state.

  Other services paid at the network rate

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.

 Avoiding out-of-network costs

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, which is known as balance billing.

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 Find a doctor or call UMP Customer Service.

 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 network provider by:

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 United States 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 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.

 Need help?

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