You can also find more information on ABA Therapy by viewing the ABA policy on the UMP Policies that affect your care webpage. See the Directory pages at the beginning of this booklet for links and contact information. Autism treatment To determine how a service, supply, or intervention is covered, see that specific benefit. For example, Applied Behavior Analysis (ABA) Therapy is addressed on page 43; speech or occupational therapy is addressed on page 72 under the “Therapy: Habilitative and Rehabilitative” benefit; and mental health coverage is found under “Behavioral health” on page 44. If a specific benefit is subject to limits, such as number of visits, these limits do not apply when the services, supplies, or interventions are for an autism diagnosis. Bariatric surgery TIP: Contact UMP Customer Service to locate a provider. For the plan to cover bariatric surgery, you must get preauthorization from the plan and follow all your chosen facility’s bariatric surgery requirements. This includes working with a multidisciplinary bariatric surgery team and ensuring your surgery and postsurgical treatment meet all plan medical policies. The plan covers only certain types of bariatric surgery procedures. If you meet the plan’s clinical criteria, non-Medicare adults age 18 or older will be eligible for covered bariatric procedures. Related care following bariatric surgery Panniculectomy (removal of loose skin) is covered following bariatric surgery when specific medical criteria are met. Most panniculectomies are considered cosmetic and are not covered. UMP will cover medically necessary surgical follow-up care related to a covered bariatric procedure, such as care for complications and needed revisions. The follow-up surgery must be appropriate and essential to the long-term success of the initial bariatric surgery and must be preauthorized. Members who had a bariatric procedure before coverage under a UMP plan and have complications or need medically necessary revision are not required to verify prior coverage or that they met the plan’s medical policy criteria for the initial bariatric procedure. However, you must follow plan requirements for follow-up care, including requesting preauthorization. Behavioral health Support network provider type: You must use a UMP Plus–PSHVN provider or a covered provider within the support network to receive network level benefits (see description in the “Support network providers” section). The plan covers behavioral health services including care for mental health and substance use disorder. You pay the inpatient rate when admitted to an inpatient facility, and the standard rate for all other care and services. When you receive nonemergency services from an out-of-network provider at a network hospital, network hospital outpatient department, network critical access hospital, or network ambulatory surgical center, you pay the network rate and cannot be balance billed for services performed in Washington State or 44 2024 UMP Plus–PSHVN (PEBB) Certificate of Coverage