Your preauthorization role ALERT! Excluded, experimental, and investigational services do not require preauthorization because they are not covered by the plan. To confirm whether a service is covered, contact UMP Customer Service. To be covered, some services, including, but not limited to, Applied Behavior Analysis (ABA) Therapy for members age 18 or older (see page 40) and bariatric surgery (see page 41), must be preauthorized before services are received. A preferred or participating provider may be required to request preauthorization before providing services. Contact UMP Customer Service to ask if a service requires preauthorization and how to submit a request. An out-of-network provider is not obligated to obtain preauthorization for services that require a preauthorization because they do not have a contract with Regence. If an out-of-network provider does not obtain a required preauthorization in advance of the service, you will be responsible for all charges billed to you. 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 104 2024 UMP CDHP (PEBB) Certificate of Coverage