You are encouraged to request that an out-of-network provider preauthorize certain services on your behalf to determine medical necessity before the services are provided. They have the clinical details and technical billing information needed to submit a request. You may be liable for all charges if you receive services that are determined to be not medically necessary, experimental or investigational, or not covered under this plan (see the “What the plan does not cover” section). ALERT! See the “Complaint and appeal procedures” section for how to appeal denial of a preauthorization request before receiving services. List of services and supplies requiring preauthorization or notice For a list of services and supplies requiring preauthorization or notice: • Visit the UMP Policies that affect your care webpage. • Contact UMP Customer Service to request a printed list or ask questions. See the Directory pages at the beginning of this booklet for links and contact information. ALERT! The UMP preauthorization list is updated throughout the year. The fact that a service does not require preauthorization or notice does not guarantee coverage. Notice for facility admissions Your provider must notify the plan upon your admission to a facility for services requiring plan notice. You may find a list of services requiring plan notice by visiting the UMP Policies that affect your care webpage or contacting UMP Customer Service. Facility admissions for which the plan is not notified may not be covered. Notice is usually done by the facility at the time you are admitted. Notice is not the same as preauthorization and many services require both. What is the difference between preauthorization and notice? ALERT! Many services, including, but not limited to, inpatient services, require both preauthorization and notice. Contact UMP Customer Service or talk to your provider if you have questions about services needing preauthorization or notice. “Preauthorization” is when your provider sends a request for coverage of a service on the UMP preauthorization list. Preauthorization is usually requested by the provider performing the services. The plan sends either an approval or denial of coverage. If the plan does not approve services that require preauthorization before services are received, the plan may deny coverage. The plan does not approve or deny preauthorization for services that are not on the UMP preauthorization list. 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage 105