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UMR, Illinois Complaints & Reviews - incompetence

UMR Contacts & Informations

UMR

Posted:    E Jbour

incompetence

Complaint Rating:  100 % with 39 votes
Contact information:
UMR Health Care
Illinois
United States
Constant clerical errors
not forthcoming about important medical coverage information
dishonest about receiving and sending important medical documents and appeals
constant evasive tactics to avoid paying rightful claims
Comments United States Health & Life Insurance
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 16th of Aug, 2010 by   ruzinee 0 Votes
UMR works in a way to help their own selves. I have been to the doctor a numerous time, and because I did not have insurance for the whole year last year, they send a questionnaires to the doctor and myself to see if the reason for the visit was for a pre-existing or not. UMR is very tricky with the questionnaires as well. They ask on there if you have ever been sick with same condition and if the medicine is the same as this time, for the condiditon.
So for example, if you go in for a UTI, which is suppose to be covered, doctor gives you medicine for it and it then goes away and you are okay, you get sick again for the same reason again, then you get the same medicine, its now considered a pre-existing according to them and will deny your claim.
Another example, you go in and you think its a kidney stone for the infection, the doctor writes it was probably a stone, but not sure need futher studies, they write that on your charts, send it to the insurance, and they then deny you if you write that down on your pre-existing questionnaire.
SO in the long run you are then denied for stones !
You then have to go through the process of appealing and so forth.
I am dealing with that right now, and was ordered by the doctor to have my kidneys screened through CT Scan and have not been able to for the past 6 months because we are still working on the denial appeal claim!
This insurance is absurd! I had another insurance prior, until my work changed it and it was great. The doctor or myself never received these stupid pre-existing forms to fill out. By the way, my prior insurance was AETNA. Great insurance!!! No bull pre-existing questionnaires to fill out EVER! aside from that deductible was great!
 25th of Jun, 2012 by   T. W. +1 Votes
I cannot understand how UMR gets by with these things. They are doing the exact same thing to us. We send in documents and send them in, they request more and keep saying they didn't get them. When I insist I already have spoken to another rep and give them time and date that they had already admitted they have it, they "suddenly" find it. I came right out and told them that i think they do these tactics to keep from paying and I think it is horrific for them to do so. Our daughter was involved in a terrible bicycle wreck in which her face and mouth were permanently severely scarred. Even though our deductible for her was paid, we still had so much of it to pay ourselves. The 10% of the hospital bill, then other bills rolled in. They kept saying we had met our max out of pocket, yet so much of it is denied that we are paying out the nose for these bills. Each and every single step must be pre-authorized, which is a total waste of time, and no easy feat either. Once the work is done, that was approved by phone, letter and told to the provider by UMR, they then deny the charges anyway over the dumbest things! Three of her top teeth were badly chipped. We don't have dental on our policy but due to the accident they have to cover it. The dentist didn't even charge for the 3rd tooth as she was able to smooth it out. She charged to repair 2 of the teeth. They had to fax in the entire plan, all X-rays etc and explanations. It was denied, denied, then approved. We scheduled and got the work done. First they then denied based on thinking it was a cleaning and fillings for teeth because the dentist called the repair, putting on fillers. After no less than 5 faxes explaining in greater and greater detail, they finally said ok, then only paid for half. The reason? After the two teeth, was the number 4, this indicated 4 sides to each tooth was done. UMR claimed they had charged twice for 4 teeth on each billing even though it was very reasonable, obviously not charges for 8 teeth, the exact teeth were numbered and pointed out on the X-ray PLUS the doctor explained fully in the explanation what it was and how many teeth. I had to call 8 times to get it resolved, NOW they are arguing about the prophylaxis that was done which is basically a deep cleaning, but it is needed to make the filler material adhere to the teeth. UMR is claiming they will pay but were never billed for this. The dentist has mailed, faxed and spoken to them numerous times, but today UMR said again, we have never been billed! The dentist referred our 14 year old daughter to an orthodontist as she cannot close her mouth when eating. Now, she needs braces due to the teeth being moved. UMR said no because we have no PROOF that her mouth ever closed prior to the accident...WHAT????? Well, my daughter was in a photo shoot a couple months or so before the accident so I was able to provide proof of what her mouth looked like before the accident. UMR acted like we were trying to get our daughter's dental work done free. They kept saying it was only a bike wreck - in a condescending manner. I got angry and sent in the pictures of her in the hospital, after the surgery, and present pictures as well as before the accident. They have been sent in 3 times now and today they said they had received no pictures, I even sent them by email. Just to put this in prospective, our daughter had like 137 stitches in her mouth. She had interior, exterior, and dissolve able stitches. She skid approx 4 to 5 feet on her face on hot asphalt. Her upper lip was skinned down 7 layers. Her bottom lip was torn down and wrapped to her chin, her nose was skinned completely, the gravel nearly got into her left eye it was so bad. Her nose was ripped free from her face. The scarring is terrible on her upper lip and looks like someone chewed a wad of gum, that was flesh colored and stuck it to her upper lip. Her top teeth came down and tore a jagged hole in her face between the bottom lip and chin, the bottom teeth came up and punctured the flesh above her upper lip and below her nose. She is traumatized and when she discovered all the scarring was permanent went into a deep depression. While we are dealing with all that, it is upsetting 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.
 14th of Jan, 2013 by   Savare +1 Votes
My son had a chronic cough and trouble breathing so I brought him to ER. He insurance company refused to pay the bill stating it wasn't serious enough. They stated that he shouldn't have been put on meds for bronchitis. Now I am dealing with lawyer to get this resolved. I have never seen a worst insurance than UMR. So sad they take advantage of people.
 18th of Apr, 2013 by   turkeystuffing +1 Votes
UMR avoids paying claims(usually the more expensive claims) by assigning bogus code numbers which allows them to deny payment on certain higher priced items. When you receive your UMR statement with an assigned code of denial on payment for some items and you resolve that "code" issue, they provide you with a re-assessment and it just so happens that the same item now gets assigned a new denial code. If you try to resolve that they resort to lying about what was provided to them for documentation by your doctor. Your doctor is then accused of causing the problem. And I have seen the documentation provided by my doctor(all 10 pages worth). UMR is the problem...not my doctor. So, when you try and verify they received it, they claim they only got some of it or none of it. Did I mention they lie??? And they lie to your Doctor when he/she tries to resolve the problem on what they call the peer to peer resolution for surgical procedures. And in fact if you actually get them to admit they have something in hand they say they didn't get, they still deny payment. Yes even the surgical review doctor lies...Oldest, sickest game in the insurance industry. Denying surgical procedures because they claim they don't have any documentation to support the need for the procedure is a very scary approach when it comes to a persons health. Talk to fellow employees about their success/failures dealing with UMR... you will find the same complaints from them. Its all a game to UMR for the sake of the bottom line...unfortunately, some of us will have to live with unresolved pain because UMR won't approve some surgical procedures... seeking appeals but am probably going to have to drop employer health insurance and get a different one just to get my surgery done... Sick sick company!!!
 18th of Apr, 2013 by   Savare +1 Votes
I am continuing to fight I even posted to the BBB!! This company needs to be shut down. The constantly tell me they are missing paperwork and I have sent it numerous times. The secretary that speaks to you is nothing but nasty and doesn't have a clue!!
 4th of May, 2013 by   Disgruntled Membr +1 Votes
They are the worst insurance company ever. They keep trying to remove my son from our insurance so they don't have to pay is $60, 000+ NICU bill... I'm sorry UMR but I will not stop fighting until you fork over the cash.
 17th of Jun, 2013 by   gfostooc 0 Votes
after our company changed over from communitly care, we were stuck with a insurance company that has no brains no morials and will do and say anything to keep and hold your money. i have a flex plan that after ii is said and done will have stole almost 200 dollars, and the crap you have to go though to even get anything from them is a civil suite, i am trying to go through the Insurance Commission in my state, but if your looking for a good Insurance company, i can say without question, that UMR is the worst i have ever had, and oh by the way, i am going to take them to court. i would love for them to pay alot more than they owe me. I really think they are in bed with the Obmacare people, what a train wreck that is!!!
 27th of Aug, 2013 by   medbiller2 +1 Votes
UMR has nothing to do with "Obamacare". UMR does not follow Medicare guidelines and therefore make up their own. How do I know? I'm a reimbursement specialist for a doctors office and UMR is by far THE WORST insurance company I have to deal with. We perform certain testing in our office so our patients don't have to travel to another facility. When providing UMR with the results for the test, which by the way has our office letterhead and information on it, they deny it stating that we didn't perform the test in the office. We email, fax and mail progress notes, test results, and any other information that they request only to have them deny the claim for one reason or another. They never, ever, ever, can locate notes that were submitted five or six times whether we fax them or mail them in. The other stall tactic is that they state that the "claim never made it into the new system". BS. When you call you can't speak to a representative unless you have a special access code to bypass the automated system, then that rep can't tell you anything because they can't see all the specifics of the claim so they have to once again transfer you to another rep. UMR is the worst. If one denial doesn't work, they pick another until you give up appealing or they deny the claim stating too much time has past since the original claim was submitted. Yes, call the insurance commissioner. I am. They sent our office to a collection agency for less than $2 that was overpaid on a patients claim, yes, less than $2. But they won't pay on the $25, 000 that is outstanding on our claims. Some of the claims go back to 2011. By all means avoid this insurance company like the plague that they are.
 31st of May, 2014 by   markincleveland 0 Votes
Jay Anliker is president of Health for UMR (UnitedHealthcare's TPA line of
business) and Business Process Outsourcing for Harrington
Health—also a UnitedHealthcare company. His mailing address is UMR PO Box 8077 Wausau, WI 54402-8077
 23rd of Jun, 2014 by   AarGoo 0 Votes
UMR is the worst insurance company. My Dr. Send in a request to have a procedure done UMR approved it then 1 days before my procedure UMR cancel my policy, Then to find out weeks later that I now need to pay for everything and now I'm left with a bill that I can't pay.
 12th of Sep, 2014 by   Tracy77484 0 Votes
Yep, UMR is a sucky company. I have them thru work and believe me if I could get away from them I would but I like where I work. They are slow to process claims. For one of my claims the Dr's office submitted all the requested information at least 3 times. UMR kept saying they didn't have the correct info. One time someone told me that they couldn't find any data on receiving info from the Dr office and the next day another Rep says "yes we got that on so and so date and your claim is processing". I don't know if they do this stuff on purpose or if pretty much everyone who works there is incompetent. I had to wear a holter monitor for a week and UMR is denying the claim as medically unnecessary even though about 3 months later I had to get a defibrillator implanted for a heart issue that the Dr was using the holter monitor to investigate.

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