LAKE MARY, FLORIDA -- My company just changed from Cigna to United healthcare, but the handling of my plan is done through UMR. In the last three days I have had to call four times to find information and have spoken to four different people. The three first two girls I spoke to on the first day seemed to have poor English and were not very helpful at all.
I was looking for RX advice and the first girl abruptly told me that I had to call my Rx plan. I searched for that number and seemed to have no note of this. I called back and asked for the number. I was told, patronisingly, that it was at the top right hand corner of my card. I advised that it wasn't, and could I have the number. Instead she passed me through. An hour later I had some more information to discuss with the pharmacy benefits tam and had to go the whole thing again. This time I got Dominic. He was GREAT and not only gave me the number but found it in miniscule numbers on the back of my card, right at the bottom, with no clear indication of what the number was for.
Today I had to call again to ask for help finding a provider. Not only did they refuse to email me the names of the providers, the girl made it pretty clear she did not have the time to be going through names to help me, she checked if I had computer access and practically insisted I use the website..which is not the greatest thing either. My company changed from Cigna to United Healthcare at the turn of the year. I am paying a lot more for my healthcare this year and this third party bunch of jokers do not come close to providing the service at the Cigna call center. Apart from
WAUSAU, WISCONSIN -- In the Summer of 2015, when I was 56 years old, I spoke with my personal provider during a scheduled physical about some difficult and painful varicose veins I had in my right leg which were preventing me from exercising, having the ability to regularly sleep sufficiently to feel well rested, and which significantly contributed to an excessive weight gain. I was referred to a local surgeon by my provider and I verified that he was covered by my health insurance (UMR) to provide me with services with a UMR Insurance Representative. I have a family history of severe varicose veins along with a familial history of vascular and heart disease.
In October 2008 I sustained a myocardial infarction which resulted in surgery, hospitalization, and extensive cardiac rehabilitation. In 2010 I had similar veins in my left leg which were ablated through a radiofrequency ablation through the same surgeons office by another surgeon at the same Outpatient surgery center and called UMR and received no difficulty in having the procedure costs paid for. The employer and insurance through that employer that I had during the first surgery was/is the same as for the second surgery.
I informed the surgeon as I had the primary provider that I was intending to retire at the end of 2015 and that I wanted to take care of any significant medical issues prior to retiring. The surgeon agreed that this was a wise way to proceed and he informed me that 3 visits with him for visual assessment and a vascular ultrasound and photographs were necessary to meet the standards of the insurance company. On October 24th after the 3 visits with the surgeon and the vascular ultrasound and photographs were completed, the surgeon's office submitted the information to UMR Insurance for Pre-determination of need and payment of benefits.
The surgeon's office received a letter indicating that there was no need for this and that the procedure was covered under my employer's insurance plan with the surgeon and the surgery center I intended to use. Approximately a week and a half prior to the intended surgery date (November 23rd, 2015) I contacted UMR Insurance and spoke with a representative. During the contact I made it very clear that if the surgery wasn't going to be covered by UMR insurance that I would have to postpone it until such time that insurance would cover it because I did not have the available funds to pay for the procedure.
I repeated that I did not have the available funds to cover the costs of the procedure several times and each time was told not to worry. The representative assured me that the procedure was a covered procedure by my plan and the only question she had was to ask me if the surgery was going to be done in a hospital or in an outpatient surgery center. When I told her an outpatient surgery center she again reassured me that the procedure, the provider, and the intended outpatient surgical center were part of my plan coverage (indicating that it would be covered) and that I should go forward with my tentative plans for the surgery.
On November 24th (the day after the surgery was completed) a letter was generated by UMR insurance which I received the following Friday which was the day after Thanksgiving 2015. The letter indicated that the size of the vein which ablated was not 5.5mm at the saphenofemoral junction (I later found out through the surgeon's insurance liaison that the size was over 5.3 at that junction and within 2 inches below the junction it was 5.7mm) and as such that the procedure and its costs would not be covered to the cost of $16,520.
The surgeon's liaison also indicated that neither she nor the surgeon were aware of this measurement requirement at the point where it was identified. I have submitted the above information to UMR insurance along with a request for an appeal and have made numerous telephone calls to the UMR Representatives to be told that it is being reviewed and that the representative would get back to me which they never did. I have on more than one occasion requested that I be sent a written response to my appeal and I have only received an explanation of benefits notice denying my claim stating that it was not a covered benefit under my plan.
My last telephone call to UMR last week (Feb 26th, 2016) had me talking to a UMR representative, after waiting on the phone for 10 minutes who then hung up on me after she said she was going to transfer my call to another young lady who I had talked to 1 1/2 weeks earlier who said she would call me back in 2 days and in 1 1/2 weeks did not call back. The representative then later called me back threatening that she wouldn't be able to help me if I hung up on her again. That representative stated that unless I submitted another appeal there was nothing they could do.
I informed her that in January 2016 I had sent in an appeal. She stated that because my initial appeal was received while the procedure and benefits were being reviewed another appeal would need to be submitted. I have sent this in as requested on February 27th, 2016.
To this date the insurance, although they have refused the claims for this procedure have covered/paid approximately $800 and negotiated a $2000 reduction in the surgeon's costs and paid a little more than $590 to the outpatient surgery center and negotiated a $3452 reduction leaving me with $8168.00 to pay out of my limited monthly retirement pension. This process has caused me, my family, and my surgeon more than a little frustration.
SLC, UTAH -- My doctor now refuses to take UMR due to mishandling of claims. I've been with UMR 1.5 years and have had 2 providers tell me they will only take patient pay and that I will need to ask for reimbursement because they have had so many issues with payment. My current healthcare provider had 3 past due bills as UMR said my visits were not covered. I found that there was a main billing code and a sub billing code, the primary code was rejected and the secondary code was not attempted. I have had medications refused, although I have years of records why I cannot take certain 'cheaper' medications. I am working with several others at my company to pressure our employer to change from UMR. These folks seem to have the mindset of Reject first-no questions asked.
WAUSAU, WISCONSIN -- March 3, 2020
To whom it may concern,
We request immediate payment of the medical claim filed in February 2019. UMR has failed to meet all stated timelines in responding to the claim and the appeal. The UMR attached letter dated February 8, 2019 stated that UMR would respond within 45 days of receipt of the appeal. Since the UMR letter dated February 8, 2019 UMR has not responded one time to the documentation provided. Since February 8, 2019 numerous documents have been faxed to UMR as well as three certified mailings which UMR has failed to respond too. This alone is legal grounds for UMR to provide the payment immediately.
In addition, we have made numerous phone calls to Accolade who in turn has contacted UMR many times. UMR continues to make excuses such as we lost the documents, the documents were separated; the forms were not complete, etc. Each time we spoke with Accolade about the UMR failures we immediately mailed and faxed the required documents once again. The UMR excuses and response time failures are very unprofessional and will be addressed with the state of Florida medical insurance board if payment is not made upon receipt of this letter. Once again all required documentation is attached for payment to be made ASAP. We will be faxing and sending the documentation once again via certified mail.
Member ID: **
UT -- Multiple calls has not resulted in reimbursement as allowed by my insurance coverage. The claims process is to purchase prescription glasses, and then submit a receipt for reimbursement of $125. Each time I called, I was told that my purchase is allowed and I should receive a check in the mail. I called a third time and was told that my claim is showing that I purchased sunglasses, which is not allowed. Why did it take me three calls to be told that my claim was denied. Nowhere on my receipt does it say sunglasses. My receipt simply says poly lens, which is a type of material that is thinner and lighter than plastic. Now UMR is telling me to go back to where I purchased my glasses and get a receipt that states they are indeed prescription glasses and resubmit my claim. This is unacceptable.
NEW JERSEY -- To say this insurance company is a total mess would be an understatement. They routinely misprocess claims, fail to pay providers on time, reject claims for covered services, etc. I have to call and spend HOURS on the phone debating what's been paid (or not paid in many cases) on every single medical claim. UMR's customer service reaches an entirely new level of incompetence. More times than I can count, I've received information from one customer service representative that was then contradicted by the next. It is beyond frustrating. I would think twice before accepting a job again from a company whose health insurance provider is UMR.
I recently enrolled in health insurance provided by my job and regret every second of it. I opted for the flex spending account for medical and dependent care. Well they pre-loaded my medical card with funds which is fine. However, they make you put in a claim for how much your daycare expenses are which I can't pay and was given information as if the money would be reimbursed when the claim was submitted with 3-5 business days, but when I called to check with the flex department I was told by Julie that I was in the “red” or “negative” in my flex account for my daycare and I would have to have to wait until my payroll deduction equals the amount of the claim I went through hell to get.
My question is what would be the point of a dependent care flex spending account if there is no way for you to access the money when needed right away. I can't afford daycare at this point in which is why I opted for it and I haven't been able to get anything paid. I've just been given wrong information or information left out by each representative and I cannot opt out for the remainder of the year. This is the worse insurance company I have been with and you all have gravely inconvenienced me in regards to getting daycare for my son.
PO BOX 30541 SALT LAKE CITY, UTAH -- Ins. Coverage changed from anthem Blue Cross blue shield to UMR. Employer changed carriers which we as employees were forced to change as well OR decline health ins coverage. Needless to say my employer as well as 8 of every 10 members regret this change. Benefit/plan enroller very vague when enrolling and have been told 4 different dates that all the copays and deductibles previously paid into under old plan would coincide under UMR.
After being lied to and given 4 different dates it still has not been corrected and this has been since Oct 1st. We are being forced to pay FULL copay and deductibles even though we met our deductibles prior to change at 100%! The cost for member plus spouse almost DOUBLED and the deductibles INCREASED by $2000. In addition to COPAYS!, you are FORCED to use mail order and they DENY everything! 3 of my 4 medication that have been on for 10+ yrs and paid for by BCBS have been denied by UMR TWICE already and have been out of medication for 2 months now.
UMR is only about ONE thing PROFIT for them, they have NO desire, interest or concern in your health just your money. It is SO bad that I am going to cancel insurance And take my chances because why pay them $ 600 A MONTH for insurance YOU CAN NOT USE or HAVE ACCESS to. So beware if your employer offers UMR (UNITED HEALTHCARE) as your insurance carrier. Save your money and stress and DECLINE coverage, I promise you, you will only regret it if you enroll!!!
SALT LAKE CITY, PENNSYLVANIA -- I send my payment every month by overnight carrier with a signature required to prove I sent my payment. UMR is slow in processing the payments and nothing no matter when you send your payment is not posted to your account until the first day of the month. This means any authorization required for the beginning of the next month is not approved until they see the payment post to your account.
I was to have a vascular procedure on the first of the month. Although their accounting department can see the next month's payment the authorization department cannot see it. So now I have to cancel the procedure until another time. Which according to the doctor's office will not be until next year. I have to wait 3 months before I can get on the schedule again.
UMR is hands down the worse insurance company I have ever worked with through employer-sponsored medical benefits. If you are an employer, I strongly consider that you absolutely, under no circumstances, work with this organization. It has been 3 months since I filed a claim for a super-bill reimbursement. UMR has continually deflected, denied, and ignored my requests for reimbursement, despite the reimbursement clause being explicitly cited in my benefits contract. They are truly a horrendous company. Do not give them your business.