United HealthCare Services review: incompetence 28

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!

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.

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.

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!

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!

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.

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!

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.

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 [protected]

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.

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.

If you get pregnant, switch insurance. They claim to cover pre-natal visits 100% with a waived deductible as stated in your policy, then turn around and tell your doctor different. I know more about health insurance than the UMR reps. They are uneducated and rude. Not worth it. Changing insurance ASAP.

I, m a state of missouri employee the state ueses UMR, but says we are insured with united healthcare and that UMR administers the paperwork ect. Never made sense to me but you better not get sick because they are ###! I have weight, joint, mental emotional, ect, ect and docs say I need testosterone therapy, I used to be able to get the injections but haven, t had them since NOV 2014 because of further FDA regulation and UMR uncooperation, and shortages. Don, t try to remedy situations through UMR. They are very uncooperative.The docs get upset and say FDA are regulating things they shouldn, t. The last perscription the docs gave me cost so much I couldn, t get them as apparently UMR only pays for generics is my take on it. I can, t pay $1276 for it especially when I could buy it from overseas where its sold over the counter, for $68 delivered IF fda dosen, t catch it. I hate UMR with a passion! To bad the state of Missouri is last in the nation for pay and benefits. Guess I have to relocate to Belize or mexico to get treated between UMR and damned ACA

THE MOST incompetent and worst run "insurance" business I have ever dealt with. I work in a medical office and bill this "insurance" . They never contact me if there is a discrepancy about a claim and the average claim (after about 14 phone calls on average) takes 3 months for them to pay. Every tactic has been used to avoid paying claims. If you submit electronically they say they have to reject it because it violates privacy. HMMMM...thats why we HAVE EHR's. To bill insurances! All of their customer service reps are off-shore, so if you call there you MUST request a supervisor in the US. Absolutely the worst .

I'm in WI, my company self insures with UMR and as others have said they are the worst. They constantly try to shift the medical claims back to the patient rather than pay. My neurologist offers botox for migraines but he won't deal with UMR because they constantly tell him they haven't received the fax after multiple faxes or they deny the claim after they previously approved it. They are so unethical. I constantly have to fight them just to get them to pay their fair share of any medical claim I've had. It is so frustrating. Once again they tried to overcharge me on my deductible by not counting my prescription payments accurately, when I spoke to Optum RX they had the correct info and they admitted others have had this same problem. So i would say it reflects a pattern of unethical and dare I say illegal practices meant to maximize their profit at our expense. I never give up and never give in and eventually get them to pay their share, but I have to wonder how many others just give up and pay more than they should. Must be a very profitable arrangement for UMR!

I am a health care business office manger and UMR is absolutely dishonorable. They absolutely have no respect or concern for their member's care. I work for a rheumatologist who administers high cost medicines in the office. The medicine does not require a pre-authorization and a pre-determination is not available. Therefore, we are subject to medical reviews for each claim submitted. The medical review that can take 60-90 days, results in, 'the CPT with the billed ICD-10 does not require a medical review'. REALLY! That can be determined with a simple claim edit. Then the claim is sent to the processor so that they can NOT GET TO IT. Now the real game begins. UMR's processors consistently tell you that the claim is still pending in medical review. After you point out that you were already told that the review was complete and the claim is ready for processing, they make you wait while they check with then advise they see this determination, they will even read the words that support this to you and agree. Then they pleasantly advise you, the check will go out on the group's next check run. That day comes and goes and you call again. Get the same run around and the same false answer. BUT today, I got the truth... the same over extended staff member who is telling you the claim will be processed and paid on the group's next check run is the same person you are talking to. But here is the truth, she or he has to "wait for UMR to grant them time off the phone to process the claim" that they are on the phone with you about. WHO DOES THIS?! What type of insurance company is this? Mom and Pop. I am beyond frustrated. Any group using UMR should stop. They are putting a bad name to third party administrators and United Healthcare should consider terminating their association.

I work in a medical office dealing with many insurances on behalf the patient, authorizing surgeries, DME products etc. UMR makes it very difficult for a provider to access their information. What takes 1 hour -1 day at the most for the majority of companies, takes weeks with UMR because you have to jump through many hoops. I detest having to contact this company. It is obvious they do want to service their beneficiaries. I would rate their customer serve at a -0.

On UMR.com they CLEARLY state Mammograms are covered under Major Medical. Mine was denied as it was processed as Wellness. I called them & got their Repressentative Melissa go to UMR.com while we were on the phone & she said I see it. Now I have to write a letter & send it to them. I had another issue where they have made me pay my Deductible $400 & Max Out of pocket twice in 2016 I was out of pocket $4700 by the end of February 2016. They don't see it. I have sent them copies of all my EOB's which they received Oct 11th. No response & when I call they have no answers. My monthly premium which comes out of my checking account every month is $680.55 for me only. My husband pays his health insurance separate from me. They are horrible & I will do my best to turn them in to the Insurance Commissioner of the State of Indiana. I have had 7 yes 7 surgeries this year 2016. I am out of money for this crap.

I just Googled "How to file a complaint against a Health Insurance Co with the Indiana Insurance Commissioner" A very easy page popped up to file a complaint which I just completed & sent to The State of Indiana Insurance Commissioner. Let's hope this helps.i

UMR insurance is a complete scam! I pay over 600$ per month for the platinum plan (this is the most expensive "$0 deductible plan").
This plan wont even cover an emergency room visit that I had to take my daughter when she got a metal ring stuck on her finger and had to get it sawed off at the hospital. her finger was turning purple and she had started to panic. When I called UMR to ask why they denied the claim they said that it wasn't a true emergency and that I could have taker her to an urgent care. I basically had to quit my job because the insurance is half of my paycheck and will not pay any of my claims and I am not aloud to cancel until the next enrollment period.

Umr is a very bad company making their business out of ruining people's lives companies like these should be held accountable, but how else would their ceo make 66 million dollars in a year!

I would like to hear from anyone who previously filed a claim for reimbursement and was approved by their former Third Party Administrator like POMCO and then had the claim rejected when UMR acquired them. infoATechomediaDOTorg

I work for a hearing and speech center and have dealt with the same excuses from UMR. They will deny the same claim with several different denial reasons. Such as it's not a covered service, it's reprocessed then they ask for medical records, or processed again asking for other insurance info. It's all a way to stall paying. You can talk to 10 different people and get 10 different answers. When you do refer them back to previous conversations, they will just tell you that the other person gave us the wrong info, this goes on and on. UMR is the WORST.

I have been a UMR Client for Two years. I Have received three identity cards and each of them have printed on it a non working number [protected]. How can that be.

In addition, the clerks answering the phone ask the same questions that you had to answer before you got to that clerk. After asking about eight questions which have to be re entered into the computer even though the data did not change the business process in place has not been designed correctly. The last straw occurs when the clerk having received all this information transfers you to another clerk that repeats the faulty process.

I work as a us call center rep for umr and let me tell you the reason why we suck so much is our calls are run and monitor by people in India. We get monitored so severely and these people don’t speak English we are set up for failure because we don’t get marked down for doing our jobs incorrectly we get marked down for whatever new rules the Indians came up with today. It’s getting worse as more and more mistakes are happening because we don’t care about our patients anymore we care about trying to keep our jobs and hitting whatever marks the indians want us to hit. If your a member of umr and you see this complain to your hr about this because we are not trustworthy anymore tell them you need people speaking English to run an English speaking call center.

As a healthcare provider, UMR is the worst insurance company to deal with. The UMR-United Healthcare Choice Plus plan is particularly awful. If you attempt to use the UMR Provider Portal to find a Fee Schedule - forget it. The options to contact UMR require you to input a patient ID and the messaging system alerts you they'll get back to you within a couple days - NOT HELPFUL. Even wors, try to call the provider phone number, [protected], listed on the back of patient cards. Again, NOT HELPFUL, unless youre only needing fax of general benefits. Try to dial "0" or get past the automated answering service gets you nowhere. If you need to go further on the phone you need a "passcode". Where this passcode comes from is anybody's guess.