Cheating members via denials of benefit coverage and contradicting language in policy
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.