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 or 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, 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 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.