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Important: This information is effective through Dec. 31, 2009. See the changes to coinsurance, medical deductible, and out-of-pocket limit for 2010.
For Medicare Retirees: See "I'm a Medicare retiree; should I see a UMP network provider?"
Network providers have contracted directly with UMP (or are part of a network that has contracted with the UMP) to render services to UMP enrollees at a reduced rate.
- After the annual medical deductible is met, most services from network providers are covered at 90%. In Washington State and the Idaho counties of Bonner, Kootenai, Latah, and Nez Perce, use the UMP network. For services received in all other states, use the Beech Street network to receive network benefits.
ALERT! Some providers are network at one practice location but not another. If you are seeing a provider at a new or different location than usual, make sure he or she is a network provider at this location as well. If you see a provider at a non-network location, UMP pays for the services as non-network, even if the provider is network elsewhere.
Non-network providers are providers who do not contract with UMP. When you see a non-network provider, UMP generally pays 60% of the UMP allowed amount after you've met your annual deductible. Non-network providers can, and often do, charge more than the UMP allowed amount. Non-network providers can bill you for the difference between their billed charge and the UMP allowed amount.
- The amount you pay non-network providers does not apply to your annual medical out-of-pocket limit.
In some instances, non-network providers may be paid at a higher rate (80% of the UMP allowed amount) if you do not have access to a network provider in your area. This is called "out-of-area" reimbursement. Since these providers are not in the UMP network, they can bill you for charges that are above the UMP allowed amount.
- In the Idaho counties of Bonner, Kootenai, Latah, and Nez Perce, providers who do not contract with UMP are paid at 80% of the UMP allowed amount.
- When a provider is paid as "out-of-area," the amount you pay does apply to your annual medical out-of-pocket limit.
- When Medicare is the primary payer, all services provided outside of Washington state and the four Idaho counties listed above will be paid at the out-of-area rate.
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