See "Where can I get vaccines (immunizations)?" when you get your vaccines from a preferred provider.
What is an out-of-network provider for purposes of vaccine administration?
A professional provider such as a medical doctor, doctor of osteopathy, naturopathic physician, and advanced registered nurse practitioner who does not contract with Regence BlueShield or a BlueCard Program plan.
A pharmacy that does not contract with UMP for vaccine administration. A pharmacy may be network for prescription drugs and still not offer vaccines to UMP members. Make sure you ask the pharmacy to submit the claim before giving the vaccine; otherwise, you may be responsible for part or all of the cost.
A clinic, hospital, or other facility that does not contract with Regence BlueShield or a BlueCard Program plan.
What happens if I get a vaccine from an out-of-network provider?
ALERT! Vaccines administered by an out-of-network provider are paid at the out-of-network rate: 60% of the allowed amount.
If you see an out-of-network provider (see above), the plan pays for vaccines at the out-of-network rate. This means the plan pays 60% of the allowed amount, and you pay the 40% coinsurance, in addition to any amount the provider's billed charge exceeds the allowed amount. See "Comparing Payments to Preferred, Participating, and Out-of-Network Providers" for how this works.
You will usually have to pay upfront and send in a paper claim to the plan for reimbursement. Some out-of-network providers, especially physicians, will submit the claim to the plan for you; ask if you aren't sure.
Exception: You can get vaccines at a public health department, but you will usually have to pay upfront and send in a paper claim to UMP for reimbursement. Vaccines covered under the preventive care benefit are not subject to the deductible (medical deductible for UMP Classic) or coinsurance.
TIP: If you get a vaccine from an out-of-network provider, make sure that you submit your claim to Regence BlueShield as a medical claim. Member-submitted vaccine claims sent to Washington State Rx Services will be denied.