We used to have BCBS (which was pretty solid, honestly) but my spouse’s company switched to UMR this year. I had a procedure which required pre-authorization. They took two weeks to turn around an authorization and they made a specific recomendation for which device they’d approve. Then they proceeded to deny the (pre-authorized!) claim, because they’re “waiting on information from my secondary.” We’ve never had a secondary, so I called and they updated that and told me the provider should resubmit the claim. About a month later some of our children’s claims were denied too with no further information why. And, the first claim I had for my procedure has still not been paid. It’s now been two months of calling them to confirm again and again that we have never had a secondary, and each time they lose any record of the previous call. It has suddenly dawned on me that this is their scam: they routinely do this to keep their costs down, because denying claims constantly likely means a certain percentage of people just give up and pay their past-due medical bills for fear of collections or lack of understanding. I have looked at their reviews on other sites and I see this is confirmed by the experiences of others. Their representatives are weirdly aggressive on the phone and give you very dodgy answers to your questions. For instance, when we called regarding the children’s claims being denied, we asked “is this because of the secondary that we told you does not exist?” and they said “right.” It was like we weren’t asking the right questions and accidentally gave them an excuse. I have no idea what service we are actually paying them for since all they’ve done this calendar year is routinely denied each claim. Also, right on their hold music/message, they have a recorded statement which basically says if they give you information over the phone which ends up being incorrect, whatever your insurance policy states is the final factor. Imagine giving out so much wrong information that you need that obvious disclaimer right on your “hold music.” I’m growing very resentful of whomever chose this circus of a healthcare company instead of BCBS.
Has this happened to anyone else? I am looking for insight or suggestions on how to hold them to their agreements, or even how to report them if necessary. UMR is a TPA and not an actual insurance company, which I am not familiar with. If a TPA is just a middleman between the employer and our healthcare claims, do I follow up instead with the employer? It seems like a strange privacy violation for the employer to be involved in your healthcare that closely. I am sorry if these are obvious questions, but I could not find out much online because these TPA’s seems to exist in a gray area of sorts.
submitted by /u/radicalecon
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We used to have BCBS (which was pretty solid, honestly) but my spouse’s company switched to UMR this year. I had a procedure which required pre-authorization. They took two weeks to turn around an authorization and they made a specific recomendation for which device they’d approve. Then they proceeded to deny the (pre-authorized!) claim, because they’re “waiting on information from my secondary.” We’ve never had a secondary, so I called and they updated that and told me the provider should resubmit the claim. About a month later some of our children’s claims were denied too with no further information why. And, the first claim I had for my procedure has still not been paid. It’s now been two months of calling them to confirm again and again that we have never had a secondary, and each time they lose any record of the previous call. It has suddenly dawned on me that this is their scam: they routinely do this to keep their costs down, because denying claims constantly likely means a certain percentage of people just give up and pay their past-due medical bills for fear of collections or lack of understanding. I have looked at their reviews on other sites and I see this is confirmed by the experiences of others. Their representatives are weirdly aggressive on the phone and give you very dodgy answers to your questions. For instance, when we called regarding the children’s claims being denied, we asked “is this because of the secondary that we told you does not exist?” and they said “right.” It was like we weren’t asking the right questions and accidentally gave them an excuse. I have no idea what service we are actually paying them for since all they’ve done this calendar year is routinely denied each claim. Also, right on their hold music/message, they have a recorded statement which basically says if they give you information over the phone which ends up being incorrect, whatever your insurance policy states is the final factor. Imagine giving out so much wrong information that you need that obvious disclaimer right on your “hold music.” I’m growing very resentful of whomever chose this circus of a healthcare company instead of BCBS. Has this happened to anyone else? I am looking for insight or suggestions on how to hold them to their agreements, or even how to report them if necessary. UMR is a TPA and not an actual insurance company, which I am not familiar with. If a TPA is just a middleman between the employer and our healthcare claims, do I follow up instead with the employer? It seems like a strange privacy violation for the employer to be involved in your healthcare that closely. I am sorry if these are obvious questions, but I could not find out much online because these TPA’s seems to exist in a gray area of sorts.
submitted by /u/radicalecon [link] [comments]Read Morer/HealthInsurance