UMR Customer Service Issues

I recently received correspondence from UMR that left me puzzled. It mentions a possibility of the provider billing me, but upon reviewing the Note Section, it indicates that a provider-negotiated discount applies and that I am not liable for this amount due to my high deductible plan. However, I'm uncertain whether I am required to settle the total amount mentioned. Prior to receiving the UMR communication, I proactively checked with my provider's office about any outstanding services, and they confirmed I have none. If payment is indeed necessary, I am unsure whether I should pay UMR directly or if I can visit my provider's office with the UMR mail for clarification. The communication suggests a payment of $[redacted], contrasting with my provider's confirmation of no outstanding dues.

Modifier 59 is not being recognized on CPT code [redacted], causing the payment for that line item to be ignored. The system is mistakenly equating CPT code [redacted] with CPT code [redacted], but they are not the same if the modifier is correctly applied. This error has affected over 20 claims. I submitted appeals for 9 of these claims two months ago, but have not received any updates. Despite numerous calls to customer service, each time I receive conflicting information regarding the status. If this issue persists, I may have to escalate it to the MD Insurance Commission. I am seeking a resolution that involves reprocessing all claims where the modifier was overlooked and ensuring we receive the rightful payment owed to us.

I have received a bill from my medical provider, the University of Michigan, for MRI services totaling $1,[redacted].88, dated 5/15/18. UMR requested preauthorization details for MD orders (Claim ID [redacted]2 [redacted]5) related to this. I am inquiring about whether the University of Michigan has provided the required outpatient orders to UMR since none of the costs have been covered as per my network benefits. The MRI was based on a single doctor's order for an Elbow/Shoulder MRI that needed to be split between two visits. It seems that UMR may have considered the two procedures as separate orders, which they were not. While the initial shoulder MRI was covered under my benefits (Claim #[redacted]3), the elbow MRI was not. I kindly request clarification on whether UofM has submitted the necessary documentation for UMR to process the bill from 5/15/18 per my network benefits. If not, please advise on the steps I can take to rectify this issue or expedite the process before the hospital billing period ends on August 1st. Thank you, Tim Tebbe

I am writing to challenge the two bills I received from the Lafayette General Medical Center. One bill is for services on August 6, [redacted] (payment plans were set up due to my illness); the other bill, invoice #[redacted] for $[redacted].96, is for services on March 17, [redacted]. Both times, there were no beds or equipment at Lafayette General Congress Street Hospital, and the doctor ordered medically necessary transportation by Acadian Ambulance Service to Lafayette General Hospital on South College. I know you bill private insurance customers, which seems unjust. Acadian Ambulance suggested I check with my insurance to see if it's covered. Can you handle this? The ER doctors assured me I wouldn't be accountable for these bills. In April, I declined Acadian's service, and the doctor confirmed efforts to stop billing patients for necessary transportation. I've contacted the hospital billing department multiple times and received the same response.

I am Karen Greene, acting as Power of Attorney for my father, George J Abrams. My father, who is 88 years old, is a retired member from Stop and Shop and has never had payment issues with hospital stays. He is covered by Medicare. Rhode Island Hospital is perplexed by the situation and advised me to reach out to you. The number on his card did not link to his information and seems to be outdated. It is possible that he has a new card, so I am requesting a new member card for him. The address for the card delivery is 2 Clover Lane, Barrington, RI. Feel free to contact me, Karen Greene, at [redacted], if you need further details. Thank you.

I work at West Metro Pediatric Dentistry, and recently received a notification stating they couldn't process a patient's claim, without further details. I tried contacting UMR, but couldn't reach a person. When I input the service date, the automated system said there's no claim on file. Could someone share contact details so I can address this with a representative?

I recently retired from my job with employer insurance and switched to Anthem Blue Cross Blue Shield Medi Blue HMO. Unfortunately, I didn't realize that by leaving my employer insurance, my wife would lose her coverage. I had some issues with Anthem, like them refusing to cover an MRI for my shoulder. Once I discovered my wife was uninsured, I decided to disenroll from Anthem. I filled out the forms and indicated on them that I intended to re-enroll with Aetna through my former employer, even though I am now retired. Anthem was supposed to send me a letter confirming my disenrollment as stated on the form. I need this letter to re-enroll with Aetna. Unfortunately, I have lost my copies of the forms. I faxed the forms to [redacted]. Any advice on what steps I should take next would be greatly appreciated.

I have been receiving multiple phone calls and messages from different departments instructing me to contact the provider line. However, I am unable to reach them because I lack a passcode or a callback number. The automated system does not offer an option to speak with a representative directly, which is frustrating. The messages pertain to the billing department regarding a [redacted] claim for a patient named Teresa McKean, with uncertain spelling. Despite my efforts, I cannot locate this individual in our billing records. It would be greatly appreciated if someone could respond to my attempts to contact them at [redacted], and provide a phone number and extension for communication. Messages have been left sporadically throughout the hospital, but the tone of the callers has not been respectful.

I am requesting a replacement card for my aunt, Mary B., who accidentally threw hers out. The group number is [redacted]. I need this for her upcoming doctor's appointment. If you require additional information, please let me know. My name is Barbara R. from Shelton, CT, and Aunt Mary is from Stamford, CT. I spoke with someone who mentioned I need to be at her residence for her to verify this request. I can provide my email address for communication. Hopefully, with this process, Aunt Mary can receive a new card for her medical appointment. Her address is [redacted] Cold Spring Road, Stamford, CT, and her date of birth is 7-26-[redacted]. Thank you.

I work for a provider and recently received two checks from UMR. The checks are not assigned to anyone specific. When attempting to locate the recipient by entering the group number and check number on UMR's website, no patient names appear. I have been unable to reach a representative to inquire about these checks. I need guidance on how to proceed and who to contact for support regarding this matter. I must make sure we have the correct information before depositing these checks. Thank you.

I dedicated a lot of time to request my claims summary from when I was a member in [redacted]. My coverage was from Jan. 1st to July. Recently, I managed to speak to a representative who processed this for me and even called earlier today to confirm that it had been emailed. Unfortunately, I have not yet received it. It is crucial for my dealings with the IRS, so I urgently need it. The report has already been generated. My past member number with Waterstone Bank was [redacted]2. I am Pamela Keller, and the last four digits of my SS# are [redacted]. I had a 3pm appointment TODAY and require this document. When attempting to reach the representative again, I discovered the phone number was unresponsive. Despite trying four more times, I could not get through as my UMR member number is no longer active. Frustrating! Your assistance on this matter would be greatly appreciated. Thank you.

I have been attempting to access my UMR account repeatedly, encountering an error message due to too many login attempts. I am required to verify my identity via a password reset link in my email. Upon resetting my password multiple times, I am redirected to answer security questions, only to face the same error message for too many attempts. The frustrating part is UMR only offers support through phone, and not via email or live chat. Dealing with UMR seems to always result in technical issues.

A customer, Kevin O. from Jensen Beach, FL, did not provide the UMR Healthcare identifier needed for billing. Please get in touch via the email provided with the UMR healthcare ID. We require this information for billing and emergency contact details. It is important that we obtain his ID and billing information promptly. Despite our email attempts, there has been no response from him, and we are becoming increasingly worried about this situation.

I work in a provider's office where we have encountered multiple issues with PT/OT/SP authorization requests through UMR. Despite faxing in the necessary clinical documents to UMR Case Management and having fax confirmation sheets, every time we follow up for status, we are told they have not received the information. This has happened multiple times with the same case, where I have now sent the required information for the fourth time today for a post-surgical patient. When I asked to speak with a supervisor, I was informed that UMR only has Nurse Case Managers, whom I have tried to reach without success. The lack of communication is significantly impacting our patients, many of whom are post-surgical and are either delaying therapy or risking coming in without authorization. I urgently need to address this ongoing issue with someone at UMR.

I am experiencing difficulties with accessing your app and website. I require assistance but when I attempt to use the chat function, it prompts me with questions and then stops abruptly. I am unable to send messages or emails with my queries. When I try to use the app, I am redirected to the mobile website, and then to the full website. Clicking on the chat button does not yield any results. I have attempted to submit questions but have not received any response. The messages section appears empty. Do I have to rely solely on calling to have my questions addressed? I can provide screen shots and videos documenting my issues if you can provide an email address. The submit button is not functioning. I am perplexed by the complexity of the process.

I visited my primary care provider today and was surprised to learn that I owe them over $[redacted] because UMR did not cover any of my costs. I'm frustrated that my insurance policy does not cover medical visits, which defeats the purpose of having insurance. It would be helpful if UMR could cover at least some of my expenses as expected so that I can afford to continue seeing my doctor, who is within their network, for my health issues. Additionally, it would be better if they could inform me about coverage limitations before six months pass, to avoid unexpected bills for recommended lab work.

I contacted your dental division, and they confirmed that they have not received the fax sent on April 29, [redacted], to [redacted]. There may have been two omissions on the claim form that prevented the processing of the reimbursement for the dental cleaning and the two $39.00 claims. One possible reason could be that the receipt was paid in full but did not contain the necessary information or the 9-digit ID number. Your previous dentist mentioned that this ID number was either not required or unavailable. Despite submitting the claim without this information in the past, it has always been paid promptly. It seems that the fax might not have been received. Shall I resend it? Please advise on the next steps.

I am having trouble with the automated system not recognizing my member ID. Despite clearly stating "CDW then the number," it repeatedly hears "ED3." This issue is preventing us from reaching an agent to address 5 unresolved claims. No matter how many times we attempt to navigate the system, we are consistently redirected back to the main menu. This ongoing cycle of being transferred around without resolution is incredibly frustrating. Last week, I spent over 2 hours on the phone, and today, I have already spent 45 minutes trying to get through.

I have requested the original EOB three times via fax for my claims, but the fax I received does not contain the detailed information I need. It only provides the billed amount and patient responsibility in a total for all 3 lines, rather than breaking down the amount applied to the deductible and the provider's write-off. I spoke to a representative yesterday who said they couldn't access the claim because it's considered too old, dated 8/4/22. This doesn't seem right. Unfortunately, the claim has been billed and received multiple times, and I keep receiving an EOB stating it's a duplicate claim, which doesn't resolve my issue. The passcode I received has expired, and despite requesting the fax again, it has not arrived. I am having difficulty reaching a customer service representative to address my concerns directly. The reference call number I received on 1/4/23 is not helpful as I can't get through to anyone. This entire process is consuming a lot of my time.

I have been attempting to reach out for the past two days via phone and email to inquire about the status of my monthly payments. Since moving into an Assisted Living facility in Stuart, Florida, I have run out of payment coupons and am uncertain if I am current on my payments. I am also inquiring about the possibility of having new coupons sent to me. Being 87 years old, I would appreciate assistance with this matter without having to spend more time than necessary on it.