ST JOSEPH, MISSOURI -- I cannot understand how UMR gets by operating as they do. One hand never knows what another is doing. Every time you call in, a different person. One dept. cannot or claims they cannot view what another dept received. You get transferred and transferred. Promises NOT kept. No one has the correct answers. Some of the workers cannot read a description or choose not to. They appear to stall and use the worse tactics to avoid paying claims.
We send in documents and send them in again and again, UMR says they didn't get them. When I finally insist I have already spoken to another representative who had already admitted they did have it, they "suddenly" find it. I have come right out and told them that I think they do these tactics to keep from paying legitimate claims. I think it is horrific for them to put people through this at a time when you are dealing with illness and accident.
Our daughter was involved in a terrible accident. She is disfigured for life. While we are trying to handle this, we have to fight and fight and argue and argue over each and every aspect of every single claim. What is the point of pre-authorization if the claim is then denied after it is fully approved??? They kept saying we had met our max out of pocket expense for this accident, then make us jump through more and more hoops and then deny the claims anyway.
Our daughter is only 14 and has sank into a deep depression. She is traumatized by the event. While we are dealing with all that, it is upsetting and unfair to have to fight each and every single charge with the insurance company. My husband has served the State of Missouri faithfully for going on 20 years, it is a travesty and I mean a TRAVESTY to have no choice but to use this company! They offer NO dental and NO vision either in our area and never have! It is a TRAVESTY. I pray some insurance commission reads all these complaints and puts a stop to their ways as they put us through pure hell.
SALT LAKE CITY, UTAH -- UMR is a subsidiary of United Healthcare and is contracted with my spouse's employer to administer the company's healthcare plan. Last year we had constant problems with their processing our claims incorrectly. I had to make my own spreadsheet and track all of our bills and payments to ensure we were covered properly, and I spent hours contacting UMR to straighten out their mistakes. Then this year, in addition to a medical provider still owing me over $600 I've yet to get back and it was due to a mistake on the part of UMR, at the very end of the year, for the first time, UMR refused to pay for my covered pap-smear and mammogram.
I had them at the same time of year I normally do to ensure there is a full year between them, and I'd met my $2500 deductible several months before. Yet, they refused and claimed a new rule to our coverage that I am still covered 100% for a pap, mammogram, and well adult exam and labs regardless of whether I've met my deductible, but the well-adult benefit is covered only up to $500 and I'd already used it for the year.
For the first time they stuck the pap and mammogram into the well-adult exam category and said I had to pay because I'd used my $500 allotment for the year. One exam with accompanying blood lab work, a pap, and a mammogram cannot even begin to be covered by only $500, especially in Alaska where medical care costs 30-55% more than other places in the country. What a scam!
In addition, blood work I had done that week, not even related to the pap and exam, they refused to cover for the same reason, but my coverage contract states that I have 100% coverage for everything after I meet my $2500 deductible.
UMR/UHC ended up costing us an extra $3000 out of pocket at the end of the year and didn't even bother to respond to my appeals! I did get one email after I appealed a second time and forwarded the information to my husband's HR office, and in the email they asked me to be patient for a couple of days while they examined my file, and then I never heard from them again. That was last winter and it is now August.
SPRINGFIELD, MISSOURI -- We have had issues getting things paid for, for years now. The only way we ever get them to actually pay is when we threaten to sue them and take them to court, then they magically respond and do something. They also never address their own problems, even if you ask specifically why they handled one situation differently to another situation that was exactly the same.
Only one person was ever friendly and tried to get my problem resolved, and she did. And I was going through the exact same situation recently and have talked to multiple representatives and they won't even acknowledge or answer when I ask why they can't submit a claim again, which is what the lady who had helped me before had to do, which took care of the problem. The representatives just ignored everything I said and would not help me. Terrible, terrible customer service.
SALT LAKE CITY, UTAH -- All I have to say is that unfortunately I have to deal with these reps all day long since I work with insurances at a dental office. The reps have a terrible attitude! They do NOT like to help you and it all seems like a task for them. Once I spoke with a "Kristen" who denied me to speak with a supervisor and wouldn't even give me contact info. It's so common with this group of people. I wrote a complaint on their website some time back but I have not seen improvement. I hope someone who can make a change sees these reviews.
My daughter had a psychiatric emergency - I drove her to the ED of the hospital I work for knowing that insurance would pay better, but there wasn't a psychiatric bed available in our facility. After finding an "in network" facility, the ED staff social worker called a transport service to transfer her to the other facility (85 miles away). Once the claim for the "transport" was processed it processed as out of network hitting a completely separate deductible making the $1,400 bill my responsibility. At no time during the visit in the ED did anyone give me an option on how to get my daughter from hospital A to hospital B.
After finding this out I looked up the covered ambulance companies, of the 3 for the entire state none of the phone numbers worked after hours. 1 of the numbers never worked, 1 company didn't service my part of the state, the 3rd was considerably cheaper which brings up a whole other issue of collusion by my employer, the insurance company and the ambulance service.
How could they not know that the insurance company that they were going with for a 2nd year does not have the only ambulance service that they call in network? Since we are self insured it's a convenient way to pass the cost on to the employees.
SALT LAKE CITY, UTAH -- UMR/United Healthcare denied my coverage for all medical and lab expenses because they claim it was accident related. After I resolved that issue they sent me another denial letter stating it was work related and continue to deny everything including blood work. How is blood work related to an accident/work injury? This was a new diagnosis and not pre-existing which has nothing to do with work or an accident. My co-payments were $40.
UMR will find any reason possible to deny payment. Customer service is terrible and they ask tricky questions and document every word to find more reasons to deny payment. I have spent too much time doing their job by calling UMR, prior insurance companies, doctors, lab, and now worker's comp. I had to file for worker's compensation so I can be denied to prove it is not related to work. Most likely they will find another excuse not to pay. It is stated on their website that they receive “4 million calls annually”. Wow that is a lot of unhappy clients. Perhaps this is why they are not BBB accredited.
I work for a Health Plan in Arizona, and have had UMR for 2+ years. I'm a single male and don't go to the doc or hospital very often. Well that being said in 2010 when I did have to go to the Dr. and found I needed to have a minor surgery, I was OK, let's get it over with. Well UMR has denied not only claims to see my PCP, they have denied EVERY claims filed that year. And now my premiums have gone up (get this) 300% to be under the same plan and to add my son. Yes I was paying $30 (monthly) now. I am paying $167 a pay check! Who are these people and why do they call themselves an Insurance company.
I vowed to not visit any hospital or Dr this year because I don't want to end up with over $3000 in medical bills this year, as I can't afford the ones from last year. As for my Son I am scared to death what would happen if we had to go to the Dr. At this point I now understand whey people stop working and get on Medicaid (AHCCCS) because its cheaper than working for your insurance.
I work my butt off to pay my Rent, and Insurance. UMR and my job just made it 300% harder to live, but what can I do? The State of Arizona is giving Medicaid out to everyone left and right... But because I work for my money I can't even get assistance. But if I stop working, I will get free medicaid, free prescriptions, unemployment, section 8 rent, food stamps, child care, cash assistance, etc... Why work if I just stop working, they just give me everything I work for... for free!!!
BETTENDORF, IOWA -- I called the company before I scheduled my surgery, that my DR. said that I needed and they said I was approved, so we scheduled it. Then, the "nurse" that works for them denied my claim and said that I could do other things before this. I am sorry, but if the DR. said that you had precancerous cells in your body you would want them out. How can an insurance company deny someone a surgery that is to get cancer out of the body? Then, when I called her to ask questions, she never wanted to call me back. Very disappointed and will be looking for a new insurance company that cares about the customers.