UMR Health Insurance

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Cheating members via denials of benefit coverage and contradicting language in policy
Posted by on
SALT LAKE CITY, UTAH -- UMR is a subsidiary of United Healthcare and is contracted with my spouse's employer to administer the companies 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 due 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.
     
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Meeh on 2011-01-13:
I have dealt with UMR. The're an extension of United healthcare, but they are totally separate from United Healthcare. If you have United healthcare repricing your claim, then that means your spouse's employer picked United Healthcare as the network. UMR is a Third party administrator (TPA) which means the benefit will always come from the employer. They have their own procedures in how they administer, but benefits can change at anytime if the employer wants to. That means if your spouse's employer decided to put a dollar maximum on your routine benefit, they can do so at anytime. UMR can not change your benefits unless the employer tells them they want to change. Hence (TPA) which is basically me telling the insurance what I want to cover and asking them to administer the way I want the benefits covered. With that said, every plan on UMR is different and unique to each employer because they let them get very specific on the coverage. For example, the word physician can mean one thing for your spouse's employer, but can mean something totally different for my employer. Hope that helps :)
Health Care Consultant on 2011-06-03:
UMR is a third party vendor who simply administers the plan that your employer has in place. They do not set the rules of how your plan operates - your employer does. The employer is the one responsible for funding the claims, so it is not to UMR's benefits or detriment to refuse or deny claims.
PJones on 2011-11-18:
I worked for the SpecPro Inc. which is owned by the Bristal Bay Native Corp. Their insurance was through UMR (United Healthcare). I'm a Type 1 diabetic and use an insulin pump. When I needed new supplies I asked and found out that the Prescription Coverage wouldn't cover the supplies but was told that the Medical coverage would and was told to go ahead and place an order through my normal supplier. That was in March 2011 and they denied the claim. The Medical people tell me it's Prescription
Traci R on 2011-12-03:
I've never had any trouble getting claims proccesed in a timely and correct manner UNTIL my company took up with UMR! They are a mess!
S on 2012-05-07:
UMR has processed my claims incorrectly. They processed routine prenatal labs as genetic testing. Even after my doctor's office faxed an appeal, they are still refusing to cover basic pregnancy lab work, such as a complete blood count, RPR, and hepatitis screening, claiming it falls under genetic testing!
aileen on 2012-06-05:
I am still fighting on a claim for a sprain andkle over 6 months now. UMR is insisting that it is preexisting...how can a sprain ankle be pre-existing??!! They are a scam and if you have a choice, its better to get your own insurance then to go through UMR!
Scott on 2013-06-01:
UMR is refusing to cover anesthesia costs for an emergency surgery. The worst coverage I have ever had.
Carlyle on 2013-08-07:
The comment from Health Care Consultant is either naive or a plant from UMR. Of course UMR has an incentive to deny claims as a third party administrator because their contract with employers rewards UMR for how much they save the employer. UMR is terrible.
Dana R on 2013-09-24:
Up here in Alaska, I ended up getting a severe bout of headaches and watery eyes. Many doctors later, and after one ER visit, and numerous CAT SCANs and MRI's my eye doctor on a routine visit found by tear duct was infected and blocked. The antibiotic prescribed helped, but I still have symptoms. UMR refused to pay any of the claims, so Now I am in debt to numerous doctors and imaging centers, that these doctors will no longer see me, and I am up to my head in bills from these doctors, and no healthcare providers I can go see
cathy on 2014-01-19:
I think what a lot of people miss about umr is the. Fact that they are a third party administrator. Which means, they process and pay or deny claims based on the benefits the employer sets up. The employer chooses the network and which doctors they want their employees to see, they choose what to cover and what not to cover. So if you're upset about a claim that's not paid, speak with you hr dept about why they don't want it to be paid.
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Avoid if Possible
Posted by on
Rating: 1/51
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.
     
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leet60 on 2013-01-22:
You may want to contact your state insurance department to see if they can assist:

http://insurance.utah.gov

Mailing & Delivery Address:

Utah Insurance Department
State Office Building Ste 3110 / Capitol Hill Complex
450 N State St
Salt Lake City UT 84114-6901

Life & Health Insurance Section & Office of Consumer Health Assistance (OCHA) (800)439-3805
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They Are Horrible In Our Opinion- Pray You Never Need Them!
Posted by on
Rating: 1/51
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 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.
     
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UMR is a joke
Posted by on
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 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 (montly) 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
SECECTION 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!!!
     
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Skye on 2011-01-10:
Yes that about sums it up. You work, you pay taxes, contribute to society, but don't you DARE try to ask for anything back, that you've paid into. That's only for those who have that sense of entitlement, who never worked a day in their life. You left off, pell grants, for education. That's money never has to be paid back.

It's painful, but reality.
karleebarlee on 2011-01-10:
I have some acquaintances that have two little kids (18 months & 3 months). Neither of them work but get $600 a month in food stamps, $800 a month in cash assistance, and numerous other free goodies. I work 2 jobs (60+ hours a week) qualified for 1/2 tank of oil to make it through the winter, $200 a month in food stamps for two people (one cannot work due to a disease) and am about to lose my house. What I've learned is I need to start popping out the kids and quit my job so I can live free, too.
BEJ on 2011-01-10:
Go back and check you conditions of Insurance. If they are covered benefits, start with filing a grievance with them and go through that whole process. If that still does not solve the problem, check with the Insurance Commissioner in your state and file a complaint.
Anonymous on 2011-01-10:
Sad but true. I have seen so many people getting free everything and doing nothing, while others work so very hard and still come up short.
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If you are interviewing with a company that uses UMR Runaway fast!
Posted by on
Rating: 1/51
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.
     
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