PROVIDERS

Am I required to use preferred providers?

No. As a MUST participant, you are never required to see providers who are members of Preferred Provider Organizations (PPO networks). Several PPO network logos are displayed on the back of your MUST card, but you can see any licensed provider you choose, even if they are not members of those networks.

The advantage of using in-network providers is that they accept discounted rates for their services, and they will not bill you for any amount that exceeds this negotiated rate. (Keep in mind that you are always responsible for meeting your plan’s deductible and for paying any required co-payment amount.)

Is my doctor a member of any preferred provider networks?

Most providers in Montana belong to at least one of the available networks. Many providers in other states are also network members.

If you are currently a member of a MUST health plan, use this link to see which preferred provider networks are applicable for your plan: https://www.abpmtpa.com/pposelector/pposelector.aspx . This provides access to each of the networks' websites to search for a specific provider.

• You will need to enter your group number, shown on your MUST ID card.
• The Social Security Number refers to the employee’s Participant ID number (usually the employee’s SSN). If you are enrolled in MUST as a spouse or dependent, enter the employee’s SSN/Participant ID, not your own SSN.
• You may search for networks in Montana or any other state.
• When all information has been entered, click the “Find PPOs” button.

If you are not enrolled in MUST, you can still determine which providers, hospitals, facilities, and other providers are members of our PPO networks. Click here for more information.

What happens if my provider is out-of-network?

This should be uncommon, especially for providers within Montana. But remember, you are free to see any licensed providers you wish. If they are out-of-network, the negotiated PPO discounts do not apply. Instead, MUST follows what's known as "Usual, Customary, and Reasonable" (UCR) charges for paying these claims. Click here for an illustration of how UCR works (PDF document).