I’ve had UMR for around 10 months, and I’ve honestly never been so frustrated. Their website is nearly useless, with little information, and their so-called cost estimator doesn’t account for personal details.
Here are two examples:
I needed an MRI, received confirmation from UMR that it was medically necessary, scheduled it at an in-network imaging center, and checked their site, which said my out-of-pocket cost would be $0. Today, the imaging center called and said it will cost me $918 out of pocket.
My husband had an approved colonoscopy, but we received a bill for $1,500 for “our portion.” UMR’s website says routine colonoscopies are 100% covered.
I won’t even start on Optum, their mail-order pharmacy, where a simple address change took three tries to get right. Medications were still being sent to our old address after the update was shown online.
Thanks for posting! Just a reminder, if there’s a medical emergency, call 911. Including your age, state, and income can help people provide better advice. Having your EOB handy is also useful.
Preventive colonoscopies shouldn’t be subject to the deductible. But if the colonoscopy was for a medical issue or they found something, it’s no longer considered preventive and would be subject to your deductible. Also, sometimes the MRI itself isn’t subject to cost-sharing, but the radiologist’s reading of the imaging might be. It’s best to call and speak with a rep for clarity.
@John
Thanks! I was pretty sure the colonoscopy shouldn’t be subject to the deductible, but the website doesn’t have any information. I’ll definitely call them on Monday to figure it out.
It sounds like you’re frustrated, and I understand. Here’s a bit of feedback:
Be cautious with out-of-pocket estimators. Costs depend heavily on location. If you went to an imaging center specializing in MRIs, it’s usually cheaper, but if it was through a hospital, that would explain the higher cost. Cost estimators are often inaccurate without specific plan details and locations. You shouldn’t expect an MRI to be free unless you’ve met your out-of-pocket maximum for the year.
For the colonoscopy, if it’s preventive and done at the right interval (typically every 5 years for high-risk individuals or every 10 years for others), it should be 100% covered. However, if it was ordered due to symptoms, then it’s not considered preventive and will be subject to cost-sharing. If the colonoscopy was preventive, ask the provider to recode it as such.
UMR is the self-funded arm of United Healthcare (UHC), meaning your employer has more control over the plan. If you’re having issues, I’d recommend reaching out to your employer’s benefits department—they may have resources like care coordinators or advocates who can help resolve these issues.
@Valen
Thank you for the detailed response, especially regarding the MRI. I specifically found a lower-cost, in-network imaging center, but I didn’t factor in the possibility of separate charges for the radiologist’s reading of the MRI. I’m just really frustrated because my previous insurer had a very detailed website with reliable estimates and more helpful information.
As for the colonoscopy, it was preventive—my husband is 55, and it was a routine screening due to his family history. His last screening was 5 years ago, so I don’t understand the bill. I’ll look into the coding issue.
Thanks for the tip about reaching out to my employer’s benefits department. I hadn’t considered that option, but it makes sense given UMR’s self-funded structure. I’ll also keep the grievance suggestion in mind if things don’t get resolved.
@Hayden
It sounds like your husband’s colonoscopy should be coded as a ‘surveillance colonoscopy,’ which is still considered preventive. I would call the billing department and ask them to review the coding to make sure it’s correct.
UMR is also understaffed right now. My wife had a bicycle accident, and UMR initially denied part of the claim because they thought it was related to an auto insurance claim due to the mention of an ‘accident.’ It took several tries, but once we got through, the representative was helpful and got the claim reprocessed. The main issue was getting through to someone—it took a lot of patience.
Always try to understand why the claim was denied and what you can do to get it resolved. Being patient and kind on the phone goes a long way.
@Aubrey
That’s a good point. I know many companies are dealing with staffing shortages right now, so I expect to wait when I call. It’s frustrating, though, because my last insurer’s website was so well-designed that I never had to call in 5 years. Now, with UMR, it seems like the website is only there for show, and I have to call for everything.
I completely agree that being kind to the rep is important. They’re just doing their job, and being rude doesn’t help anyone. If they can’t help, I’ll just ask for a supervisor. No need for yelling or hostility—it’s about getting the right solution.
Greer said:
Have you called the provider or insurance about these issues yet?
I’m still gathering information before I call. Many of the comments here have been really helpful in pointing out things like potential miscoding or deductible issues. I want to make sure I have all the facts before I call, so I don’t have to do multiple calls and spend even more time on hold.
I plan to call on Monday about the colonoscopy bill, and I suspect the MRI is likely related to my deductible.
Make sure you have your EOBs and other documents available when you call. It helps to be specific about the dates of service and the issues you’re having, rather than discussing hypotheticals.
We switched to UMR in May, and I absolutely hate it too. I’m constantly calling to find out why they’ve denied claims. My son broke his arm in July, and they denied all the initial claims until I called and filled out an accident form. Since then, every follow-up visit has been denied until I call and go through the same process. It’s exhausting.
Greer said:
Keep in mind, cost estimators are just that—estimates. They can give you a general idea, but the actual costs can vary depending on several factors.
I get that, but a $918 difference is pretty significant. My last insurer’s estimates were much more accurate, so this feels like a big step backward.
Kelly said: @Hayden
What’s your deductible, and have you received the EOB for the MRI yet?
No EOB yet, I haven’t had the MRI yet. The imaging center called to give me a heads-up on the cost. My deductible is $1,500 annually, and I’ve only used $300 so far, so I think the $918 is related to my deductible. I did try shopping around for different imaging centers, but since I need an MRI with and without contrast, the cost is high everywhere. Plus, I have metal in my spine, so I need to go to a specialized MRI center. I had this same MRI last year with no cost under my previous insurer, but I’m not sure of the circumstances.
I’ll definitely ask UMR about it, but I’m mentally prepared to pay the full amount.
@Hayden
It sounds like it could be a deductible issue. You might want to ask UMR for the contracted rate for your MRI (with specific CPT codes and provider details). That could give you a clearer idea of the cost.
Also, last year’s MRI might have been covered differently if you had met your deductible or out-of-pocket max with your previous insurer. It’s worth checking!
@Kelly
Thanks for the suggestion! I’ll definitely ask about the contracted rate. I also called around to a few imaging centers and used the MRI code from the doctor, and most centers quoted a price in the $700–$900 range. I didn’t realize that the metal in my spine would limit my options to specific MRI centers, so that might be part of the higher cost too.